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J3S 



URICACIMMIA ; 



ITS CAUSES, EFFECTS 



A.ND 



TREATM ENT. 



PERRY DICKIE, M. D. 



Philadelphia : 

BOERICKE & TAFEL,. 

1903. 



THE LiBRA 


RYOF 


CONGRESS, 


Two Copies 


Received 


JAN 21 


1903 


\ Copyright 


Entry 


&LASS CU 


<1 6 3 
XXc. No. 


€ & %-( 


S 


COPY 


B. 




COPYRIGHTED 



BOER1CKE & TAFEL. 

1903. 



.:";!.: 



T. B. & H. E. COCHRAN, 

PRINTERS, 

LANCASTER, PA. 



DEDICATION. 



TO THK 
MEMBERS OF THE CLASS OF '80, 

IN WHOSE COMPANY THE AUTHOR PLODDED 

THROUGH THE TORTUOUS BUT PHEASANT 

PATHS OF MEDICAL LORE, THIS 

LITTLE VOLUME IS MOST 

HEARTILY DEDICATED. 



PREFACE. 

Knowing full well that the very complete 
and voluminous work, by Haig, on "Uric 
Acid," exists, and to which, by the way, the 
writer is largely indebted for much general 
information as to his interesting, ingenious, 
and valuable theories on this subject, in the 
preparation of this work, however, believ- 
ing that something smaller and more com- 
pact might be acceptable to the physician, 
on this assumption he launches forth this 
little volume upon the sea of chance, hoping 
that it will meet with some success as to 
proving of slight value to the medical pro- 
fession in elucidating the question as to the 
importance of uric acid as a disease factor. 



URICACID^MIA. 

Introduction. 

That the past history of medicine has 
been the repository of innumerable fads and 
fancies is a veritable fact to which we can 
all readily attest without the slightest feeling 
of uncertainty ; a large proportion of which 
being of a purely ephemeral and fleeting 
nature, often of no value from a scientific 
standpoint, while others of a kind more 
stable and lasting, have become, after pass- 
ing through the ordeal of trial and exper- 
ience, valuable factors of intrinsic worth. 

In the memory of the modern physician of 
extended experience and observation will 
be cognizant of three, what we might term, 
epochs or periods, in which it would seem 
that the unanimous mind of the medical pro- 
fession ran to a certain extent, as far as pos- 
sible, in one channel, that is, to the certain 
points in question ; which, by the way, as 
unanimity on any one subject in the medical 
profession being not a common occurrence. 



8 Uricacidcemia. 

we must therefore consider that when such 
as this happens it is surely deserving of the 
dignified title of epoch. 

The principles of these in their beginning, 
although rather partaking of the nature of 
fads, and to many almost a subject of ridi- 
cule, however later did each a great fetich 
become ; but time and experience demon- 
strating their full value and worth, the scof- 
fers and mockers fell into line, as well as the 
scales falling from the worshippers' eyes, 
they therefore settled into their proper place 
in the domain of medicine. 

Of the three subjects to which I have al- 
luded as constituting epochs, we have, first, 
the "Bilious," when, in the words of the 
patent medicine pamphlet, "the liver is 
(was) king ; " to us of middle age this experi- 
enced in our boyhood days, in the shape of 
treats to that delightful tasting stuff — man- 
drake — in decidedly appreciable quantities* 
or the volatile mercury, in doses however to 
us as results, certainly did belie this descrip- 
tion of its, at least, physical properties. The 
old physicians of the present day have a 
practical remembrance of this age, and fully 
know the worth of the term " bilious" as a 
diagnostic appellation to satisfy the com- 



Uricacidczmia. 9 

munity at large, whether the condition was 
a case of bile excreted in too profuse quan- 
tity, or not at all ; as this ever potent term 
was sufficient to lull the most tumultuous 
bosom to rest in quiet peace. However, 
this useful etiological factor served its time 
well, but as all things have an end, this was 
not an exception to the rule, and with the 
passage of time has now sunken almost into 
oblivion, except in patent medicine circulars, 
where its value is of tremendous import. 

Then the second of these epochs appeared 
upon the scene with " Malaria" inscribed 
upon its banners. Becoming the common 
watchword and the cry, the why and the 
wherefore for every pain and ache, the cause 
of every ill to which mankind was heir, and 
quinine in massive doses was crammed into 
the unfortunate individual very much after 
the fashion of feeding the wretched fowl 
fattened for market by means of the stuffing- 
process. 

This period is within the recollections of 
many of us during our professional experi- 
ence, and we can appreciate the tremendous 
support and mainstay that this portentous 
word has been to us ; how it has helped us 
out of many quagmires of doubt, when the 



io Uricacidcemia. 

admission of indecision or uncertainty would 
have been utter annihilation to our pride and 
dignity. 

With the inevitable decline of this period 
has been the adoption of this term with a 
signification of an actual existing state, and 
not of meaningless import as originally used. 

The third and most important etiological 
factor which has held sway ever since is 
"Uric Acid," greater than its predecessors, 
being founded upon genuine facts; in short, a 
real condition capable of producing much of 
the mischief laid at its doors, so much so that 
the use of this term, as a cause of disease, 
has not seemed to have partaken of the slip- 
shod character of diagnosis as the two former 
ever have. True, this agent in the past has 
been made a veritable pathological scape- 
goat for all the ills of humanity ; the cause 
of everything we had or might have had ; a 
cloak wherewith to cover our ignorance. 
But this is largely of the past, as uric acid as 
the cause of disease has been for some time 
settling into its proper place, as its prede- 
cessors have done ; but owing to a position 
more stable and firmer than the others, this 
decline has not been so great, or its ultimate 
position as obscure or lowly, but simply to its 



Uricacidczmia. 1 1 

rightful sphere in the domain of pathology. 
That it will ever be relegated to the past, 
as has been the case with so much in medi- 
cine, is not at all likely, for as long as we 
have the present existing state of civilizing 
influences, together with the inactive life of 
the so-called better classes, this cannot but 
be ever present as an important etiological 
factor in disease. 

Having passed through the various stages 
which every new theory or discovery in med- 
icine has undergone ; at first overestimated 
and overworked, extolled to the skies as 
potent for all ills ; in fact, claims made for 
it far in excess of its capabilities ; to be fol- 
lowed by the inevitable fall from grace, in 
which its former praise is turned into con- 
demnation ; exceptionally it has escaped 
this latter, but has surely come down from 
its heights of faddism to a mundane level, 
where it is possible for it to remain immuta- 
bly fixed and permanently established for the 
future in the domain of medicine not subject 
to the change of opinion, a possibility of ex- 
ceedingly frequent occurrence in the medical 
profession. 



SYNONYMS. 



Uricacidsemia. 

Uricsemia. 

Uric Acid Diathesis. 

Lithaemia. 

Lithiasis. 

Lithuria. 

Lithic Acid Diathesis. 

Latent Gout. 

Arthritic Diathesis. 



DEFINITION. 

Uricacidsemia is essentially a derangement 
of the process of metabolism ; an impair- 
ment of the eliminative functions of the 
body; whereby certain excrementary sub- 
stances are retained in the blood, setting up 
various disturbances, resulting in this condi- 
tion. Characterized by manifestations of a 
decidedly protean character, simulating va- 
rious other diseases, and acting as a toxic 
agent of different degrees of power, ac- 
cording to the amount retained in the sys- 
tem, and the susceptibility and temperament 
of the individual ; those of the nervous being 
most susceptible, undoubtedly owing to its 
irritant action upon the nervous system. 

True, it has been until recently a veritable 
medical scapegoat at whose door nearly all 
of the ills have been laid, when we could not 
find the true cause ; its symptoms and influ- 
ences probably in many cases largely exag- 
gerated ; still it is a bona fide etiological 
factor, a genuine pathological condition, its 
action thoroughly accounted for, and in 
every way worthy of the dignity of being 
considered a veritable disease. 



1 6 Definition. 

It has at times been termed by the fa- 
cetious or sarcastic the lazy man's disease, 
though in some ways not inappropriately > 
because the sedentary are so frequently the 
recipients of its action ; but even so it does 
not follow that all others are exempt by any 
means, although non-activity is certainly 
not a cure for it. 

A most widely prevalent and commonly 
existing complaint, being nowise a respecter 
of persons, attacking the wealthy devotee of 
fashion, who, by the way, spends two-thirds 
of the twenty-four hours in counteracting its 
effects so as to be able to eke pleasure and 
dissipation out of the remaining one-third ; 
as well as the sedentary brain-worker and 
the closely-confined man of business ; all 
being a victim of its pernicious effects. 

The only class of humanity free from its 
bad results and escaping the attending con- 
sequences is the hard working son of toil, in 
whom the functions of metabolism are in 
such a complete working order that waste 
products in such have no chance to accumu- 
late, but are rapidly and completely elimi- 
nated as soon as formed, as intended in the 
normal process of nature. 



URICACID^MIA. 



METABOLISM. 

The ultimate normal object and end 
of all nutritive matter taken into the 
body is for the purpose of the building 
up of the tissues and the replenishment, 
of waste. This following upon the prep- 
aration of the food for assimilation by 
means of the digestive processes in the 
stomach and intestines ; which passing 
from the latter through the lacteals and 
blood vessels, is carried to the various 
tissues to replace the never ceasing 
losses entailed upon them by the pro- 
cesses of life, besides in addition to this, 
in children and young people supply- 
ing the material for their bodily growth. 
A constant change going on in the 



18 Metabolism. 

body by which the protoplasm of the 
cells is being destroyed and the new pro- 
toplasm built up by the assimilation of 
the food. 

This process of life is resultant of 
waste material normally carried from 
the tissues by the blood, and by means 
of its several excretory functions, urine, 
perspiration, etc., is discharged from 
the body. 

Regarded as a whole, these changes 
taking place in the human economy, 
from the assimilation of the food to the 
deliverance of the waste products to the 
organs of excretion, although complex 
and purely of a chemical nature, are 
characterized under the general term of 
" Metabolism." 

Composed of two factors : Anabol- 
ism, or assimilation proper, a construct- 
ive process relating solely to the build- 
ing up of the tissues ; and Katabolism, 
a destructive process consisting of the 
combustion or breaking down of tissue 



Metabolism. 19 

into a lower state of oxidation, with 
the consequent formation of waste 
products, as carbonic acid, water, and 
the various nitrogenous substances, 
urea, uric acid, etc. Those which 
concern us principally in this connec- 
tion being confined solely to the nitrog- 
enous, of which uric acid is the main 
factor, although it is claimed by some 
that there are also other bodies with it 
in exercising its deleterious influences. 
However, for all practical purposes we 
may assume this to be the one. 



ORIGIN OF URIC ACID. 

Uric Acid like urea is a waste product 
of the metabolism of nitrogenous prin- 
ciples , and varies entirely in quantity 
with the character of tlie food taken. 

. Of the several theories as to its 
origin, that of the liver being the seat 
is not well authenticated, as this organ 
contains but a small amount, and the 
blood in the hepatic vein containing no 
more than that which, is conveyed to 
the liver by the portal vein. As it is 
found in considerable quantity in the 
spleen, and as the return blood from 
this gland must enter the liver, it 
would serve to explain the amount of 
uric acid emerging from the latter 
organ. 

To the kidneys has also been at- 
tributed the function of the formation 
of this substance, but there is also a 



Origin of Uric Acid. 2 1 

lack of any positive data on this point. 
Another theory which has had many fol- 
lowers, is that uric acid, like the other 
constituents of the urine, is separated 
from the blood by means of the se- 
lective power of the epithelial cells 
lining thetubuli uriniferi of this organ. 
But the most generally accepted opin- 
ion, however, the most plausible as 
borne out by results and facts, seems to 
be in favor of the view that uric acid 
is formed within the tissues, and simply 
eliminated in the urine by the kidneys 
as a mechanical process, as far as it re- 
lates to them. 



OCCURRENCE OF URIC ACID. 

Uric Acid is a permanent constituent 
found in the urine in combination with 
sodium and ammonium, constituting 
the " acid urates ;" is slightly soluble 
in water, but readily so in alkaline 
fluids, as the blood, and when separated 
from these bases, due to an excessive 
amount of uric acid, appears in the 
typical, whetstone, crystalline form re- 
sembling grains of Cayenne pepper. 
By some it is claimed to be ever pres- 
ent in the blood in varying amounts. 

As to the normal proportion of the 
elimination of uric acid authorities 
differ, some giving five to eight grains 
per twenty-four hours on a vegetable 
diet, proportionately increased accord- 
ing to the amount of nitrogenous food 
ingested, about ten to fifteen grains in 
the same period. 



Occurrence of Uric Acid. 23 

While, according to Haig, it varies 
in proportion to the urea in the ratio of 
one to thirty-three ; the urea ranging at 
from three to three and a-half grains per 
pound of body weight, which in a man 
of, say, one hundred and fifty pounds, 
would be somewhat over fifteen grains 
in the twenty-four hours. Therefore, as 
to this point, we can readily see that 
the subject is not as clear as one 
would wish for. 

The amount of uric acid excreted 
will materially vary with the diet, but 
it is not the excretion of this product in 
its normal amount or excess that gives 
us any trouble, but its retention in the 
system that does so. 

The occurrence of uric acid in the 
body in normal proportions is, of course, 
as we know, the result of the meta- 
bolistic functions, an excretory waste 
product ; but when in excessive quan- 
tities constituting a pathological condi- 
tion, is to be attributed to one of two 
causes. 



24 Occurrence of Uric Acid. 

i. A fault in the process of Katabol- 
ism, whereby the eliminative matter, 
the ultimate end of which should be 
urea, being by reason of some patho- 
logical process, this oxidation is not 
carried far enough, and as a result we 
have uric acid instead. Essentially 
constituting a jpathological condition, 
or, 

2. Simply an increased formation due 
to a diet largely consisting of nitroge- 
nous substances ; the uric acid derived 
therefrom, which not being properly 
eliminated on account of its excessive 
amount, or certain conditions existing 
which do not favor its excretion, accu- 
mulates in the body; an increased elim- 
ination taking place at times of quan- 
tities stored up in the past, and re- 
moved by the alkalinity of the blood. 
Partaking more of a purely physical 
process. 

Haig and others deny the former of 
these, and claim that the latter is the 



Occurrence of Uric Acid, 2 5 

only cause. The writer is of the opin- 
ion that it is possible for both to be at 
times causative factors in this condi- 
tion. 

Uric acid being soluble in alkaline 
and insoluble in acid solutions, its pres- 
ence in the blood would depend upon 
the reaction of that fluid, which condi- 
tion is almost entirely influenced by 
the food taken, bodily exercise and 
temperature. In regard to which latter, 
exercise increases and cold diminishes 
the alkalinity. 

Although uric acid may be ever pres- 
ent in the blood, still its quantity 
varies largely in the twenty-four hours, 
which, according to Haig, is in excess 
when the acidity of this fluid is low, 
from four or five in the morning to two 
in the afternoon. During which period 
the so-called " alkaline tide " occurs, 
about nine in the morning to twelve 
o'clock noon, when it is in an amount 
three-fold that of the other period. 



26 Occurrence of Uric Acid. 

The excess at this time not being 
due to any increase in formation, how- 
ever, but simply an elimination of that 
retained or stored up during the other 
portions of the day, when the acidity is 
in excess, or, more properly expressed, 
the alkalinity is low. 

The other period, from two o'clock 
in the afternoon to the early morning 
hours, is termed the " acid period,' ' not 
that its reaction is at any time acid, 
but simply less alkaline, when the 
urates being rendered more insoluble 
they are in it in a lesser amount. This 
period is also influenced by diet, cold, 
etc., as is the other, and the quantity 
of uric acid also fluctuates, in which 
we find it from about three to six in the 
afternoon, to be less acid, and is some- 
times termed in consequence the second 
alkaline tide. 

These periods are of considerable im- 
portance in explaining the various 
phenomena occurring in cases of 



Occurrence of Uric Acid. 27 

uric-acidaemia, as the appearance of 
symptoms and other manifestations of 
this condition. 

Exercise and work increase the alka- 
linity of the blood, bringing into it the 
uric acid, which if stored up in the 
tissues in any considerable amount is 
the cause of fatigue. Those who exer- 
cise most retain the least uric acid, and 
in such the storing up is little, if any, 
consequently their fatigue is but a 
minimum ; but in the sedentary and in- 
active this is retained in large quantities 
and they therefore tire on the slight- 
est exertion. For instance, gout, in 
which we have this storing up pro- 
cess at its maximum, seldom, if ever, 
attacks the laborer. 

Cold and winter weather by dimin- 
ishing the perspiration, there is a con- 
sequent retention of its acids in the 
system, therefore keeps the alkalinity 
of the blood low, whereby the uric acid 
retained in the body is driven into the 



28 Occurrence of Uric Acid. 

tissues, or, according to Haig, may also 
be thrown down in a colloid form in 
the blood when in too excessive quan- 
tity to be taken into them. 

With high uric acid there is a low 
acidity and urea, also a diminished 
urinary secretion, its excess (uric acid) 
in the blood obstructing the circulation 
of the kidneys, thus preventing diuresis, 
and with which condition we have an 
accompanying high blood pressure. 

Fevers cause acidity of the blood, 
with its attendant rapid combustion of 
the tissues; but in time, as the vitality 
of the system becomes worn out, this 
decreases and the blood becomes more 
alkaline. Resultant on this excess of 
stored up uric acid being excreted is to 
be attributed the various sequelae of so 
common an occurrence. 



EXCRETION OF URIC ACID. 

Haig considers the absolute amount 
of uric acid excreted as of less import- 
ance than its relation to the urea 
passed, which, as we have said before, 
should be in the ratio of one to thirty- 
three, with the urea at three to three 
and a half grains per pound of body 
weight. The amount of uric acid 
eliminated in the urine is increased or 
diminished by the greater or lesser 
alkalinity of the blood, owing to its 
solubility under these circumstances. 

An increase of this product is usual 
for a day or so after the administration 
of alkalies or sodium salicylate, pre- 
sumed to be the uric acid stored up in 
the tissues and various organs, during 
which period it is to be found in in- 
creased quantity in the blood and the 
urine. 



30 Excretion of Uric Acid. 

A diminution of the alkalinity of 
the blood for any length of time results 
in a diminished excretion of uric acid. 

In youth there is always a minus ex- 
cretion due to a lessened amount of 
waste products in the process of de- 
velopment, winch at maturity is in- 
creased, while at old age the output is 
larger still. 

In spring, especially, and summer a 
larger excretion occurs, as heat in- 
creases the alkalinity of the blood ; de- 
creasing in autumn and winter, as cold 
diminishes the alkalinity of this fluid, 
and, therefore, drives the uric acid into 
the tissues, except when present in an 
excessive amount, causing a condition 
of discomfort and sensitiveness to the 
cold so common in individuals suffer- 
ing from this complaint (uricacidsemia) . 

Many persons, when the warm 
weather of spring comes on, suffer 
from malaise, fatigue on the least ex- 
ertion, and a general feeling of wretch- 



Excretion of Uric Acid. 3 1 

edness, attributed by certain elderly 
females versed in medical lore to sundry 
marvellous pathological causes, as 
"thickening of the blood," " spring 
blood humors/' etc.; the true explana- 
tion being an accumulation of uric acid 
in the system during the cold months, 
due to confinement indoors, sedentary 
life, or a diet of too heavy a nature ; 
consequently when the heat coming on 
and the blood becoming more alkaline 
this stored up product coming into it in 
increased quantities and being excreted 
causes a condition of at least discom- 
fort, if not sometimes symptoms of a 
more serious nature. 

All substances which increase the 
solubility of uric acid in the blood aug- 
ment also its excretion in the urine, 
while all those which diminish its solu- 
bility by causing acidity or lowered 
alkalinity lessen, also its amount in the 
urine, driving it into the tissues and 
causing a condition of irritation to 
those susceptible to its influence. 



3 2 Excretion of Uric Acid. 

In the latter class are to be in- 
cluded mineral acids, wines, beers, etc., 
which, as we know, cause gout by free- 
ing the blood from the uric acid con- 
tained in it and sending it into the 
tissues and joints. 

Certain drugs form soluble com- 
pounds with uric acid, or, by making 
the blood more alkaline, aid in its 
elimination through the kidneys, as the 
alkalies, sodium and potassium, also 
salicylic acid and the salicylates, and, 
when the alkalinity is low, salicin and 
salol also acting in this way. 

Besides sodium phosphate, in a 
highly alkaline media only, as well as 
piperazine, quinine and belladonna, as 
also a vegetable diet, by diminishing 
the acidity. 

In opposition to this we find certain 
other drugs forming insoluble com- 
pounds with uric acid, thus not allow- 
ing of its excretion, as the various acids, 
especially mineral ; the metals, as iron, 



Excretion of Uric Acid. 33 

lead, mercury, silver, copper, zinc, 
lithia, manganese, calcium; the sul- 
phates, chlorides, etc., besides acid 
sodium phosphate ; or else raising the 
acidity (lowering the alkalinity), there- 
fore resulting in insoluble compounds, 
as opium, cocaine, iodides, antipyrin, 
ammonium, nitrates and various com- 
pounds of sulphur. These all diminish 
the excretion of uric acid by clearing it 
out of the blood and circulation, but 
bring about its retention in the 
tissues, joints, spleen, liver and other 
organs, resulting in a train of symp- 
toms exactly the reverse of those ex- 
perienced when it is retained in the 
blood In fact, a condition of stimula- 
tion. 

Even lithia as a solvent of uric acid, 
hitherto so highly extolled as a panacea 
for all conditions attributed to the re- 
tention of this product, according to 
Haig, while it removes the uric acid 
from the blood, never reaches this 
3 



34 Excretion of Uric Acid. 

substance itself, but by combining with 
the phosphates in the blood lessens its 
alkalinity, thus driving it into the sys- 
tem. 

Likewise cold, fevers and alcoholic 
beverages cause a condition of acidity, 
holding back the urates in the tissues. 



ETIOLOGY. 

Uricacidsemia is essentially a disease 
of comparatively modern times, due to 
a pernicious mode and method of life, 
inactivity, diet, etc. The consequences 
and results of an imperfect excretion of 
the waste products in the act of living, 
either through an excess of nitroge- 
nous substances taken into the system 
there ensues such an accumulation ot 
these products whereby the oxidizing 
functions are overwhelmed and unable 
to dispose of them by excretion, or else 
a condition in which the metamorphosis 
in the human economy is not carried to 
completion through a fault in the 
chemical processes in the bodjf ; in 
other words, instead of urea, perfectly 
soluble and easily eliminated, the ulti- 
mate excretory and product of the 
metabolism of nitrogenous substances, 



36 Etiology. 

owing to an incomplete oxidation, they 
consist of nric acid, which, possessing 
different properties as to solubility, 
elimination, etc., is retained in the sys- 
tem, acting as an irritant to the various 
structures and organs. 

Owing to what is termed an increased 
acidity of the blood, but in reality 
simply a diminished alkalinity, being 
unable to hold the uric acid salts in 
solution, a deposition of this substance 
takes place into the tissues, a condition 
of affairs we find in gout, and, accord- 
ing to Haig, also in rheumatism, two 
diseases which he claims to be identi- 
cally the same as to their etiology, dif- 
fering, as he considers, simply in the 
former being more localized and the 
latter more of a diffused character. 

But the more common forms of 
uricacidsemia, however, are those de- 
rived from the presence of uric acid in 
the blood, its occurrence there due to 
an excess in the system, in an amount 



Etiology. 37 

not possible to permit this fluid to be 
free from it at any time. 

To this condition Haig attributes an 
innumerable train of symptoms, also 
going so far as to make it an etiological 
factor for various actual diseases, as 
epilepsy, apoplexy, etc. While the 
more conservative would not feel will- 
ing to agree with him in all his reason- 
ings and theories, still we cannot but 
admit that his explanations sound very 
plausible, and we are sometimes almost 
carried along with him in his surmises ; 
but we must admit, however, that he 
supplies us with valuable etiological 
reasons for some conditions hitherto 
not accounted for, and while we at the 
present time do not admit all of his 
theories, still, however, much of them 
are to be accepted as of great value, as 
supplying many missing links in the 
etiology of disease. 

Of importance as a causative factor 
in this condition is an inherited 



38 Etiology. 

tendency on the part of some, derived 
especially through gouty parents, the 
transmission by tlie male side being 
more common, manifesting itself by 
means of the various symptoms char- 
acteristic of this condition. 

In such cases we have most assuredly 
what has been termed a " uric acid dia- 
thesis/' denied by some as not existing, 
among whom Haig being one who dis- 
putes it. 

Among the causes of this condition 
we will find anything which tends to 
promote a sluggishness of the process 
of assimilation and excretion. 

The most important of which in 
contributing their share, we may men- 
tion, a sedentary, inactive life as tend- 
ing to lower the par of the system, too 
much confinement indoors, with insuffi- 
cient fresh air, practically starving the 
blood of the necessary oxygen for the 
complete metamorphosis of this product 
into urea, which, being deprived of it, 



Etiology. 39 

thereupon seizes upon what is available 
in the blood corpuscles. 

Errors in diet and excess of food are 
also attributed as a cause, possibly due 
to their natural impairment of the 
health, rendering the subject suscep- 
tible to, in fact, any deleterious influ- 
ences. 

A neurotic temperament and too 
much worry we would expect to predis- 
pose an individual to a condition so 
liable to arise from a cause of such an 
irritating nature to the nervous system. 

Inasmuch as sufferers from this con- 
dition are usually worse in cold weather, 
this has been given as one of the causa- 
tive factors; but, unless the blood of the 
subject is pretty well charged with uric 
acid, I do not think he would be likely 
to be influenced by low temperature, 
rather, according to Haig, it would, if 
but in small quantities, be removed 
from the blood, but if present in large 
amounts would be precipitated in it, as 
he expresses, in " colloid n form. 



40 Etiology. 

Another cause that has been ad- 
vanced is too little water drinking, 
which it seems hard for us to realize 
how this could be ; and also the use of 
alcohol and tobacco is accredited by 
some as producing this condition. 

As to the action of tobacco in this 
state, it does not seem to be well under- 
stood, and as to alcoholic beverages we 
know that they cause a lessening of the 
alkalinity of the blood, driving the 
uric acid into the tissues, especially so 
in the case of rich wines, as port, 
sherry, champagne and burgundy, also 
malt liquors and porter. Spirits having 
the least prejudicial effect. 

But the principal and most common 
factor in producing this trouble, is an 
excess diet of animal food, of which 
beef is the most pernicious, together 
with the xanthins, tea, coffee, etc. 
Yielding as they do a large amount of 
nitrogenous matter, which, if partaken 
of in too great a quantity, taxes the 



Etiology. 41 

metabolistic functions to an extent not 
possible to effect a complete conversion 
of the products into urea, but stopping 
short at a lower grade of oxidation — 
uric acid. 



SYMPTOMS AND PATHOLOGY. 

We cannot but admit that the evi- 
dence is pretty strong to lead us to be- 
lieve that a large number of diseases of 
the human body owe their causation to 
the effect of uric acid, which by its con- 
trolling action upon the circulation, as 
well as its irritant properties, exercises 
a deleterious power over the processes 
of life to a very great extent. That it 
is a possible cause of many pathological 
conditions although not the only one. 

Its pathological action being due to 
two factors, viz.: 

i. The direct irritant effect on the 
tissues owing to its presence in them in 
considerable quantity, as we find in 
gout or rheumatism. 

2. Its presence in the blood, obstruct- 
ing the capillaries through the vaso- 
motor system ; affecting the circulation, 



Symptoms and Pathology. 43 

nutrition, function, and temperature of 
all the organs and tissues of the body ; 
also producing high blood pressure 
which directly affects the heart and 
vessel walls, as well as the intracranial, 
thoracic, and chylopoetic circulations. 

The presence of uric acid in the blood 
causes an increased arterial pressure, 
with slowness of the pulse (brachy- 
cardia) , attributed by Haig to an actual 
plugging or occluding of the smaller 
capillaries by this substance in a form 
termed by him " colloid " uric acid ; but 
this savors so much of the etiological 
factors of a century ago, that a more 
satisfactory theory should be sought for. 
The writer is of the opinion that its in- 
fluence on the blood pressure is really 
due to uric acid in this fluid, irrespect- 
ive of form, either colloid or crystal, but 
without doubt at all times in solution 
when in it, and acting as an irritant to 
the vaso-motor nerves, causing a spas- 
modic condition of the muscular coats 



44 Symptoms and Pathology. 

of the vessels, thus bringing about the 
same results in a lessening of their 
calibre, interfering with the circulation, 
deranging nutrition and resulting in 
structural changes, controlling the 
heart's action by slowing the pulse, 
and ultimately resulting in cardiac hy- 
pertrophy ; interfering with the action 
of the renal and pulmonary circulation, 
with also headache and depression, and 
from the impairment of nutrition and 
metabolism a resulting anaemia and 
hsemoglobinuria. 

The various manifestations of the 
presence of this product in the blood 
are not in all cases continual, but owing 
to an excess accumulation in this fluid 
and the system being unable to dispose 
of it, we have what are termed " uric 
acid storms ;" the location of the 
trouble depending, it would seem, 
largely upon the local susceptibility of 
the patient; attacking as a rule at the 
weakest point. These attacks being 



Symptoms and Pathology. 45 

followed by the elimination of these 
offending waste products, with a conse- 
quent fall of blood pressure, diuresis, 
and subsidence of the symptoms and a 
temporary lull, during which time the 
capillaries thus freed is followed by a 
quickened metabolism and combustion, 
a comparative feeling of well being 
and apparent immunity from disturb- 
ing symptoms; these periods varying 
as to length, during which time the 
uric acid is again accumulating, and 
when the system is again overloaded 
with this product to recur again, and 
so on repeatedly, until effective treat- 
ment is instituted or the patient gives 
out. 

On the other hand, in some we find a 
lesser variation of the condition, with 
a more or less continual state of ma- 
laise, depression, wretchedness, etc. 

The non-elimination of such a seem- 
ingly trivial quantity as six to seven 
grains — or even fifteen grains, according 



46 Symptoms and Pathology. 

to Haig — of this excretory product in 
twenty-four hours would seem but a 
small matter, but when this keeps pil- 
ing upon itself for days and even weeks 
or months — possibly years — we can 
readily understand why the system be- 
comes so thoroughly saturated, and it 
is, therefore, no matter of surprise to us 
that it causes all the trouble attributed 
to it. 

The action of the uric acid on the 
human economy (in a simile by Bur- 
nett) is identical with that of the soot 
in our chimneys (we would suggest also 
that of clinkers), interfering with the 
well behavior of our stoves, or in case 
of those of us who have to endure it, 
that very essential article to our com- 
fort, but, at the same time, hygienic 
bane of civilization, the hot air furnace, 
the cause of the majority of the catarrhal 
and neurotic evils with which we are 
afflicted. 

Without doubt a heavy eater of 



Symptoms and Pathology. 47 

nitrogenous food actively engaged in an 
occupation which keeps his excretory 
functions in perfect working order ; his 
urine might show an amount of urea 
and uric acid far in excss of the normal 
amount, and yet the individual, at the 
same time, enjoying perfect health ; but 
take a person of sedentary habits on 
even a moderate nitrogenous diet, where 
the urine shows an amount of urea and 
uric acid not above the normal, and 
symptoms of its retention will seldom 
be absent, due to accumulations of it in 
the system. If in a patient of a neurotic 
temperament or a tendency to the much 
scouted at uric acid diathesis, the con- 
ditions will be more aggravated still. 

Although this complaint is possible 
in all, still the individual in whom 
uricacidaemia most frequently occurs 
is usually of a neurotic tendency, non- 
active and sedentary, susceptible to 
cold, with a deranged digestion and 
very often badly working kidneys; 



48 Symptoms and Pathology. 

with a lowered vitality and deficiency 
of haemoglobin in the blood. 

In the normal subject the consump- 
tion of haemoglobin being considerable, 
the demand for it is, therefore, large ; 
the uric acid of the waste products by 
means of this substance being oxidized 
into urea, as more soluble and of 
easier elimination; therefore, when this 
product is in excess, a greater tax is 
levied on the blood in its oxygenating 
functions, in which case accounts for 
the resulting and ever present anaemic 
condition. 

In fact, a constant destruction of the 
red blood corpuscles in a varying de- 
gree of severity. 

The excretory functions, therefore, 
taxed to their utmost by the increased 
amount of this product, and usually 
inadequate to the task, the result of the 
existing high arterial tension and pres- 
sure, as well as also the general im- 
pairment of the health ; its elimination 



Symptoms and Pathology. 49 

is thrown upon the liver and kidneys 
with consequent derangements of these 
organs, often of a serious nature, as 
hepatic cirrhosis, biliary or renal calculi, 
albuminuria, interstitial nephritis, etc. 

As a rule, in all these conditions of 
uricacidaemia we have present symp- 
toms of nervous irritation, as various 
forms of neuralgia, mental depression 
irritability, and bad temper, insomnia, 
weak memory, worrying and annoy- 
ance, also numbness of the extremi- 
ties, etc. 

This, together with the deficiency of 
haemoglobin, and the small amount of 
heat generated and consequently but 
little radiated, renders the subject sus- 
ceptible to cold, all huddled up and 
afraid of the slightest breath of air, 
from which exposure to, a cold is in- 
variably the result, and with this con- 
sequent lack of reserve vitality making 
him unable to throw it off, therefore 
hanging on for an indefinite and pro- 
tracted period. 
4 



50 Symptoms and Pathology. 

Gout is a condition resulting from 
uric acid, and, according to Haig, rheu- 
matism also, the two closely allied ; the 
difference being that in the former 
occurring in but one joint, of longer 
duration and severity with a deposition 
into its tissues of biurates ; while in the 
latter it occurs in several joints, is of 
shorter duration, of less severity, and 
the urates are present in the tissues in 
solution ; the pain worse at night on 
account of the acidity (less alkalinity) 
of the blood, when at that period it is 
driven into the tissues. Besides in gout, 
although there is a diminished alka- 
linity of the blood, there is not a gen- 
eral clearing out of the uric acid from 
it, while in rheumatism the uric acid is 
all driven out of this fluid, the reaction 
of which is also less alkaline, but is in 
the tissues a short time only and not in 
crystalline form. 

Gout seldom attacks those engaged 
in bodily labor or on a vegetable diet, 



Symptoms and Pathology, 51 

but as rheumatism, however, does very 
frequently occur in the working classes 
this, therefore, constituting a weak 
point in his theory. 

As these diseases do not often appear 
until the individual is advanced in 
years is accounted for by an accumula- 
tion of uric acid in the system from a 
previous diet of meat, tea, coffee, wine, 
beer, etc., manifesting its presence at 
this late date. 

Malaise, disinclination to do any- 
thing, and fatigue on the slightest ex- 
ertion, caused by the fact that exercise 
and motion increase the alkalinity of 
the blood, when the uric acid stored up 
in the tissues, being soluble in this 
menstruum, therefore its invasion into 
it with the production of these symp- 
toms. 

Exposure to cold when the blood 
contains uric acid, if in small amount, 
drives it into the tissues, but in case it 
is in excess and not possible to remove 



52 Symptoms mid Pathology. 

all from it produce various disturb- 
ances, as lumbago, pharyngitis, bron- 
chitis, tonsillitis, rhinitis, etc.; in fact, 
attacking that part of the body which is 
the least resistant to its influence. 

Therefore in an individual loaded 
with uric acid a cold climate is most 
effectual in producing a defective work- 
ing of the various functions and a faulty 
metabolism. 

In warm weather the attacks from 
uricacidsemia will be less frequent 
owing to the fact that warmth is con- 
ducive to alkalinity of the blood and 
an increase in the excretion of the 
urates. 

For this reason when the first warm 
weather comes on after winter there is 
such a general sense of malaise and 
that " tired feeling," in a more or less 
degree, as we have stored up uric acid 
during the cold months from a diet too 
heavy for our insufficient inactivity ; 
while those who have not accumulated 



Symptoms and Pathology . 53 

this product in the system have little 
or no depression at this time. 

As to the effects of cold on a system 
full of uric acid, its precipitating action 
will cause trouble when large quantities 
are retained in the blood, exercising a 
paralyzing effect upon the circulation, 
nutrition and metabolism, accompanied 
by mental depression and an exceeding 
sensitiveness to the cold. When, how- 
ever, but little uric acid is in the sys- 
tem cold acts as a stimulant, raising 
the acidity of the urine, lowering the 
alkalinity of the blood, and therefore 
clearing it of these waste products con- 
tained in it, thus stimulating nutrition 
and metabolism ; consequently those 
who live on a diet free from uric acid 
feel the cold less and require less cloth- 
ing in winter than those who eat much 
meat and xanthin compounds. 

Frequently we meet persons who 
complain, as they express it, of " feel- 
ing wretched," or else their symptoms 



54 Symptoms and Pathology. 

are worse, during the early part of the 
day, but during the afternoon begin to 
feel better, and by night time feel per- 
fectly well, this occurring repeatedly; 
also in cases of deranged digestion, 
where the evening meal is best borne, 
the others causing considerable dis- 
turbance, especially that at midday, so 
much so that total abstinence from food 
at this time is sometimes compulsory. 

This is to be accounted for from the 
fact that during the morning hours the 
increased excretion of uric acid takes 
place, which, if excessive, is the cause 
of this trouble ; while in the afternoon 
and evening, due to lowered alkalinity, 
it is present in the blood in but very 
small quantities, hence the apparently 
stimulating effect of mental activity 
and well being. 

One of the most common and fre- 
quently complained of symptoms is 
headache, paroxysmal or periodic ; 
identical with migraine, bilious or sick 



Symptoms and Pathology. 55 

headache, so-called, lasting twelve to 
forty-eight hours, accompanied by 
nausea, vomiting, coldness, chilliness, 
etc., the patient going to sleep and 
awakening in the morning free from it. 
Often in females, occurring around or 
at the menstrual period. These are 
practically " uric acid storms," due to 
the overflow of a storing up of this 
product and its consequent passage 
through the blood out of the system, 
which, when all excreted, the headache 
passes away and does not return until a 
new supply has accumulated, when an- 
other storm ensues. These occurring 
more frequently in individuals with 
large supply arteries in the brain ; as a 
rule, the intellectual and brain workers 
(although the ignorant are not exempt), 
also those of sedentary occupation ; in 
fact, those whose cerebral vessels are 
of greater extent and calibre, with slow 
high tension pulse, accompanied by 
coldness of the skin and extremities, 



56 Symptoms and Pathology. 

brought on by some extra exertion or 
muscular effort or after fatigue. 

Also from crowded assemblages, 
churches, theatres, etc., poorly ventil- 
ated, due to the heat and deficiency, in- 
creasing the alkalinity of the blood, 
when uric acid if present in the system 
enters into it. 

In regard to the above it would seem 
that churches are a more prolific causa- 
tive factor, on account of a tendency to 
neglect to the important hygienic prin- 
ciple of ventilation. Theatres are less 
so on account of the large stage, mak- 
ing it impossible to exclude air entirely 
from them, and therefore less liable to 
be a cause of this trouble. 

Bearing upon this subject, inasmuch 
as these complaints are quite frequent, 
the writer has in view a church at 
which he knows an individual who has 
attended there frequently, but if morn- 
ings, in few cases without being laid up 
the rest of the day with sick headache ; 



Symptoms and Pathology, 57 

also, he recalls the case of a lady who 
has been obliged to stop her attendance 
there, as invariably on doing so she 
would faint away during the services. 
In a conversation with one of the em- 
ployees, he innocently informed the 
above party that during the cold season 
they seldom permitted the fresh air to 
enter the building ; as when they at- 
tempted to warm it again, as he ex- 
pressed it, the hot air all went up to 
the top and it took too much coal. 

Verily, a modern " Black Hole of Cal- 
cutta," in a mild way. 

Possibly the question of ventilation 
in our churches may have something 
to do with the non-attendance of which 
we hear so many complaints. 

It is certainly the cause of the drowsi- 
ness that so many experience. 

This plea of headache on attending 
church has been sneered at and scouted 
at by many, but the writer knows there 
is more truth in it than the doubting" 

c> 

ones would have us believe. 



58 Symptoms and Pathology. 

The presence of uric acid in the 
blood causing, as previously explained, 
a raising of the arterial pressure, symp- 
toms of this will of necessity manifest 
themselves. When the respiratory or- 
gans are the susceptible parts, asthma 
is often present ; the attacks when 
coming on in the early morning hours, 
as is so frequently the case, due to low 
blood pressure, free capillaries and 
quick pulse of the night; with the 
" acid tide " of the blood ; giving place 
to the high blood pressure ; obstructed 
capillaries and slow pulse of early morn- 
ing ; the " alkaline tide " of this period. 

In fact, the exacerbation of all symp- 
toms and conditions so frequent at this 
period in the twenty-four hours, we 
here find a ready and satisfactory ex- 
planation, for inasmuch as this has 
hitherto been unaccounted for in any 
way to meet the requirements of a 
mind seeking for the why and where- 
fore. 



Symptoms and Pathology. 59 

Also as a result of the continued high 
tension, derangements of the circula- 
tion are apt to occur, as arteriosclerosis, 
and later, various cardiac lesions, espe- 
cially hypertrophy. Angina pectoris is 
also a symptom attributed to this con- 
dition. 

The increased labor put upon the 
kidneys in the elimination of the ex- 
cess waste products, together with the 
high arterial tension, if allowed to con- 
tinue, as a result ultimately we will 
have a diseased condition of these 
organs, albuminuria, interstitial ne- 
phritis, etc. 

But the amount of excretion should 
not influence us in an opinion, as in a 
healthy kidney with low alkalinity of 
the blood, the uric acid may be very 
scanty, leading us to infer that this 
organ is diseased, which under some 
conditions, when so, may excrete a con- 
siderable amount. 

Haig, who, as I said before, attributes 



60 Symptoms and Pathology. 

to this condition a very large number 
of ailments to which humanity is heir, 
also considers this a causative factor 
in epilepsy, convulsions, hysteria, and 
like ailments, due to an interference of 
the cerebral circulation on account of 
the high blood pressure. To this he 
also attributes diabetes, glycosuria, and 
Raynaud's disease (symmetrical gan- 
grene), the early stages of which are so 
characteristic of uricacidaemia with its 
cold extremities, etc. 

Regarding which it would seem that 
inasmuch as his arguments are, as a 
rule, the most plausible of any hitherto 
advanced for them so far, we would not 
be making a very great mistake in ac- 
cepting them, at least for the time until 
something better turns up. 

In individuals with a weak digestive 
tract of necessity this will here cause 
trouble from attacks of indigestion, 
more or less protracted and of varying 
degrees of severity. 



Symptoms and Pathology. 61 

In some, cutaneous manifestations 
will occur, as urticaria, eczema, etc. 

Those with weak respiratory mucous 
membranes will also not be allowed to 
escape the effects of this agent, and in 
the nose we will find frequently a neu- 
rotic rhinitis, and a condition of the 
turbinals in which on the slightest 
provocation a congestion will occur, 
occluding the nostrils and causing the 
individual an amount of annoyance not 
appreciated except by those so affected 
in this manner. 

Uric acid is considered to be one of 
the causes, by some the one, of hay 
fever ; of both the neurotic condition 
necessary for it, as well as also that of 
the hyperesthesia of the mucous mem- 
brane, rendering it susceptible to the 
local irritant setting up this condition. 

Enlarged tonsils and also lymphoid 
enlargement of the pharyngeal tonsil 
are by some attributed to an inherited 
gouty diathesis. 



62 Symptoms and Pathology . 

In regard to the character of the 
symptoms developing as a manifestion 
of the presence of nrie acid in the 
blood, the writer is of the opinion that 
according to the temperament of the 
individual so will these be. 

In the so-called sanguine or full 
blooded we will find derangements of 
the circulatory system, as congestive 
headaches, cardiac and kidney lesions, 
arteriosclerosis, and also gout. 

In the nervous temperament various 
neuralgias, and especially in these in- 
dividuals do we find affected with hay 
fever and the several respirator}^ neu- 
roses, as asthma, neurotic rhinitis, etc. 

In the bilious temperament lies the 
susceptibility to sick headaches, also 
many liver, spleen and gastric troubles. 

The phlegmatic temperament seems 
to be less susceptible to the influences 
of uric acid than any of the others, yet 
why is not clear, as persons with this 
temperament are, as a rule, prone to 



Symptoms and Pathology. 63 

inactivity, even sometimes laziness in 
the highest degree, and very often large 
eaters, both of which being potent fact- 
ors in the production of the uric acid 
condition ; therefore why this class of 
individuals should be free from its 
effects has not yet been explained. 
Possibly for the reason that their ex- 
cretory functions are, as a rule, more 
active, bowels more open, skin perspir- 
ing more profusely, and kidneys free, 
thus rapidly eliminating this product 
as soon as it is formed and not allowing 
it to accumulate, is the only explana- 
tion it seems possible to offer at present. 



TREATMENT. 

General Remarks. 

In the treatment of uricacidsemia 
drugs, although useful as far as they 
go, have but a limited sphere of action 
in this condition, and while efficient 
agents when used at the proper time 
and place, still are of lesser importance 
compared with the various hygienic 
factors, which we will soon discuss as 
to their use in this complaint. 

To cure our patient suffering from 
this trouble more than a mere prescrip- 
tion and some general platitudinic ad- 
vice is necessary as to the regulation 
of his mode of life ; but to be successful 
in leading him along the path to bene- 
ficial results, at least, if not perfect re- 
covery, the slightest detail of his living 
must be arranged and regulated for 



Treatment. 65 

him, if lie will not follow out and con- 
form to the advice given him by the 
physician, in case of failure the fault 
will then be his only, for in the 
instructions given him for his cure, if 
sufficiently explicit, the physician will 
have then done his duty. More than 
this would not be possible. 

However, if we neglect this more 
important part of the treatment we are 
most certainly derelict in our duty, no 
matter how much as an offset we ply 
him with drugs, for with these alone no 
permanently curative results need be 
expected. 

Our principles and mode of life 
should not influence us as to what is 
hygienic unless we ourselves conform 
to its regular adopted principles as ac- 
cording to authorities on this subject. 
In short, we must prescribe genuine 
hygienic principles for our patients 
and not fads of our own concocting. 
For instance, the healthfulness of 



66 Treatment, 

alcohol and tobacco never has been a 
fact, although some of us use them and 
live through the effects ; even it may be 
that we have had an ancestor in days 
gone by who was addicted to the prac- 
tice of these agents in large quantities 
and yet lived to the age of ninety years 
or thereabouts. Without doubt if this 
same party had cultivated better habits 
he would have lived to over a hundred. 

In uricacidaemia we have a condition 
of toxaemia, a poison in the blood, being 
continually introduced by means of our 
diet, with two-fold indications for treat- 
ment ; firstly, to eliminate the waste 
products that are present in the sys- 
tem in excess ; and secondly, to pre- 
vent the new supply from coming in ; 
and until this is done the trouble will 
not cease. 

Cures are not, as a rule, possible, 
that is, to alter the life processes of the 
individual so that he can return to his 
former unhygienic way of living with- 
out suffering inconvenience again or 



Treatment. 67 

the old symptoms returning, but by 
the change of injurious habits to those 
of a healthful nature, very few cases, 
if not all, will experience more or less 
relief, prevented only according to the 
amount of structural change that has 
taken place, and in these cases where 
this has not occurred we may hope for a 
complete return to health. 

But that the cure of this condition by 
drugs alone is possible, is about as 
reasonable to expect as that a fracture 
or the removal of a foreign body 
treated only by internal medication, 
without any mechanical procedures, can 
be accomplished successfully. 

Bver remembering the above indica- 
tions in the treatment of uricacidaemia, 
elimination of the excessive waste 
products, and prevention of their re- 
formation ; when this is accomplished, 
then by means of drugs treat the symp- 
toms arising, when we will find our 
remedies to come into play and with 
gratifying results. 



TREATMENT. 

Hygienic. 

Under this head we will include as 
essentials in the treatment of uricaci- 
dsemia, the following factors : Exercise, 
Baths, Clothing, Air, Climate. 

Exercise. We may not follow out 
this principle ourselves, or insist upon 
it in our patients, save in a casual way- 
suggesting it to them as an optional 
matter ; but none of us will deny that 
proper exercise is absolutely necessary 
to perfect health, and for the proper 
performance of the functions of life ; 
quickening the circulation and increas- 
ing its flow throughout the body, aug- 
menting the respiratory process by 
causing an enlarged demand for oxygen 
and the expulsion of carbon di-oxide, 
also hastening and aiding the elimina- 



Treatment. 69 

tion of the waste products of the body, 
by means of the various excretions, as 
the urine, perspiration, etc. 

In health this is necessary to keep 
well, and even in the invalid, as much 
as he can take without fatigue, is advis- 
able ; but when we crowd exercise 
unlimited, as is advised by the majority 
of the laity and many physicians, upon 
an individual full of uric acid and 
unable to dispose of the already in- 
creased amount of this waste product 
in the system, we by means of the 
formation of more, through this addi- 
tional exercise, instead of bettering, as 
is intended, simply aggravate the con- 
dition. 

Physical exercise creates a demand 
for haemoglobin which at this time the 
debilitated system cannot supply, also 
increasing the quantity of toxic waste 
products, which, not being rapidly 
eliminated, the patient consequently 
suffers from the bad effects, besides 



70 Treatment. 

draining his vitality and with a non- 
resisting recuperative power causing 
the resulting condition. 

A mild systematic exercise in the 
open air is not only beneficial but ab- 
solutely essential, but not to be carried 
beyond the balance of repair and waste, 
no further than the stage of slight 
fatigue, increasing daily if possible 
nntil a considerable amount can be in- 
dulged in without tiring the patient, 
ever making an effort to enlarge his 
powers of endurance. 

In this, however, we cannot hope for 
any success until the uric acid is out 
of the system. This accomplished, and 
its recurrence prevented, then our ex- 
ercise is a valuable prophylactic and 
remedial measure, and not a means of 
aggravating the evil, as it would be if 
nsed alone as a mode of treatment as is 
so commonly advised. 

Baths are necessary to stimulate the 
skin to its normal functional activit} 7 > 



Treatment. 7 1 

also to keep open the excretory ducts. 
For the first of these cold, always fol- 
lowed by friction, is considered prefer- 
able ; but for the second, which is 
synonymous with cleanliness, warm 
water is necessary. 

In weak, debilitated subjects the cold 
bath is not advisable on account of its 
depressing effects upon the heart, and 
the non-liability to an early reaction. 
In patients who are cold, chilly, and 
feel bad for several hours after, this 
should be avoided, but in a case where 
an exhilaration and well being follows 
immediately after the bath they may be 
allowed. 

As a rule, however, for the uric acid 
patient, warm baths will be more often 
required, as the action of cold on this 
product acid being to cause its retention, 
the very things we wish to avoid. 

On account of the liability to take 
cold afterwards, they are, therefore, pref- 
erable at night before going to bed. 



72 Treatment. 

For those who must have their morn- 
ing cold bath, either from an exagger- 
ated sense of cleanliness, or in whom 
a tonic and exhilarating effect is really 
produced, I would strongly advise in 
lieu of this that a sponge bath is all 
sufficient, invariably followed by a brisk 
rubbing with a crash towel,which is fol- 
lowed by a glowing feeling and a sense 
of warmth, we may safely allow such ; 
but in the stage of uricacidsemia this 
mode of bathing is not advisable until 
in the patient, the stored up products 
are eliminated and the increased forma- 
tion has been stopped. 

Remembering that cold checks the 
elimination of uric acid, which outflow 
being greatest during the morning 
hours, the cold morning bath will tend 
to interfere with this excretion, and 
even though the patient may feel well 
after it, should a sense of discomfort, 
wretchedness and depression occur dur- 
ing the afternoon hours, due to an 



Treatment. 73 

excessive deferred action at this time, 
we may infer that uric acid is being re- 
tained in the system as a result of this, 
and therefore the cold morning bath 
should be discontinued. This may ac- 
count for the afternoon nap so obliga- 
tory to some individuals, although 
apparently unnecessary from their 
slight exertions. 

The pernicious practice of the cold 
plunge bath, introduced by the few and 
followed in a lamb-like way by the 
many, simply because it is a fad ; 
cannot but be condemned for general 
adoption by the average individual of 
the present day. 

I verily believe that the increased 
prevalence of cardiac and renal diseases 
is due to the wholesale and indiscrimi- 
nate indulgence in this practice, espe- 
cially on the part of adults ; although 
the young and hardy may be able to 
withstand its entailed strain upon the 
system. 



74 Treatment. 

By its action driving the blood from 
the surface, thereby congesting the in- 
ternal organs, this cannot but be in- 
jurious to them, and with any tendency 
to weakness on their part, serious de- 
rangements are liable to result there- 
from. 

That certain strong and hearty indi- 
viduals who indulge in them and seem 
w r ell is not by any means indicative of 
their healthfulness, but simply that 
they are hardy enough to endure the 
continued strain. 

It is a significant fact, however, that 
as so many of these apparently robust 
and strong ones pass out of the world 
so suddenly from kidney and heart dis- 
eases, generally like the snuffing out of 
a candle, it has occurred to the writer 
to ask the question, could not this be a 
means of possibly contributing towards 
this result ? 

The baths should be taken as hot as 
the patient can comfortably bear them, 



Treatment. 75 

and quite frequently ; subjects well 
charged with uric acid are often bene- 
fited by one every night, but in all cases 
it should be tried, when if no debilitat- 
ing results occur it should be kept up 
until symptoms of excessive retention 
of uric acid disappear, when they may 
be gradually lessened. 

Clothing is another point of import- 
ance to be looked after at all times. 
Woolen underwear, preferably Jaeger's, 
should be worn next to the skin all the 
year round, varying in thickness accord- 
ing to the season. 

Silk or other material, no matter 
how much advertised or highly puffed 
up — even if more expensive — will not 
take its place. I fully agree with one of 
our authorities — I forget who — who, in 
writing on this subject, expressed his 
opinion as to silk underwear, that its 
preference by so many he attributed 
solely to its costliness. 

Air must be fresh, pure, and in 



76 Treatment. 

\ abundance at all times, night and day. 
The patient must sleep in a well ventil- 
ated room, as cold as he can do so with 
comfort and no resultant bad feelings 
in the morning on awaking. 

During the day in the case of weak 
and debilitated subjects, avoiding any 
exposure to cold before, say, two o'clock, 
in cold weather remaining indoors until 
this time ; this is advisable so as not to 
interfere with the normal process of 
the " alkaline tide." 

The apartments through the day 
should also be provided with good ven- 
tilation, and in cold weather not heated 
by steam, or if so, a pan of water should 
be kept boiling in the room to relieve 
the excessive dryness resultant on this 
mode of heating. In some ways I think 
the hot-air furnace is worse ; not so 
much on account of the dryness, which 
is bad enough, as from the fact that 
it seems about impossible to have one 
so regulated as to ran even throughout 



Treatment, 77 

the day ; it being the usual thing to 
shiver and shake in the early morning 
hours, possibly be comfortable during 
the middle of the day, and at night to 
swelter from too much heat, just the 
very time it is not wanted. 

In this I think a large majority of 
persons will agree with me as to their 
experience with the hot-air furnace, oc- 
casionally there being a few exceptions. 

Besides a gas-tight furnace is prac- 
tically an impossibility ; consequently 
the air we breathe, when one of these 
is in operation in our house, contains 
at all times in a more or less dilute 
form such delectable bodies as carbon 
monoxide, and dioxide, together with 
hydrogen sulphide, all highly poison- 
ous gases, and our only salvation being 
that they are usually present in but 
small quantities ; but even then enough 
so to be deleterious to our health, mak- 
ing us feel wretched and disinclined to 
work. 



78 Treatment. 

The ideal method for all who can 
afford it is by means of hot water, as 
near perfection as we can ever hope to 
reach in this world, insnring us at least 
a complete immunity from poisonous 
gases from this source, and besides 
granting us a equable temperature at 
all times. 

Of course, I refer to these means of 
heating in our cold climate with our 
disagreeable winters, as where a wood 
fire is sufficient it is the most hygienic 
form of heating, next to it being the 
grate fire; these being the methods pref- 
erable to all others. Stoves are but 
makeshifts, and not to be advised at 
any time, except when nothing else is 
available, and being a case of necessity 
knows no law, the individual who has 
to endure them is to be most heartily 
pitied. 

For these class of cases an outdoor 
life, as much as possible, should be in- 
dulged in. This cannot always be 



Treatment, 79 

carried out to an extent really necessary 
to our usually severe winter climates ; 
and even our springs of late have been 
a travesty on the term as usually under- 
stood, viz.: sunshine , singing birds, 
blossoming flowers, etc., etc.; but in the 
summer months and early fall, even 
late spring, when possible to do so, the 
patient should remain out of doors all 
day, and at night in a room well ven- 
tilated. 

In a country perfectly healthy, a dry 
air, free from dampness, camping out 
is to be advised as most beneficial in 
every way. 

Individuals not able to exercise 
should sit or lie in a hammock in the 
open air, of course not exposed to 
draughts or wind, but in sheltered and 
shaded situation. 

In short, fresh air in abundance at 
all times is an absolute essential to sup- 
ply the anaemic blood its oxygen, with 
as little effort on the part of the system 



80 Treatment. 

as possible, and in a pure and unadul- 
terated form. 

Climate is by no means of minor im- 
portance, as few of these cases but what 
a change of air is absolutely necessary 
for their recovery if their condition is 
beyond that of medium severity ; in 
fact, all will be benefited. 

Inasmuch as the uricacidsemic pa- 
tient, as a rule, is also a neurasthenic, 
as well as being the possessor of a weak 
heart, a seashore or a mountainous 
region for aggravated forms of this 
complaint are both contraindicated, the 
former on account of its too stimulat- 
ing properties, the latter due to its bad 
effect upon the heart ; but what we 
would advise in this condition is a 
healthy hill country, with an altitude 
sufficient to insure a fresh, bracing 
quality to the air, but not high enough 
to tax the heart. 

An altitude of ten to twelve hundred 
feet above sea level seems to the writer 



Treatment. 81 

about right for such, cases as these. 
Another important point to be taken 
into consideration is the avoidance of 
great contrasts between the night and 
day temperature, the prevalence of sud- 
den changes and also the liability to 
cold or hot " snaps. " Of course, these 
conditions will occur in all portions of 
the globe to some extent, more or less ; 
but our endeavor should be to find a 
place where the lesser changes prevail, 
and such is more apt to be in a medium 
altitude than in the extremes. 

No doubt there are innumerable loca- 
tions to fill these requirements, but the 
difficulty is to find them when we need 
them ; in fact, when in a hurry we 
have not the time to look them up and 
must take what is recommended to us, 
sometimes to our exceeding regret and 
discomfort. 

Having spent many seasons there, 
the writer has ever been of the 
opinion that to largely satisfy the 
6 



82 Treatment, 

requirements of an individual suffering 
from an aggravated form of uricaci- 
daemia the country around Sharon, 
Connecticut, is perfectly suitable and 
conducive to good results for cases of 
this complaint ; often while invalids, in 
fact though not apparently so, but who 
need a quiet country life with city com- 
forts, minus its bad air, smells, noise 
and other characteristic features of a 
disagreeable nature, Sharon is fully 
adapted for them in every way. Situated 
in the hills of Northern Connecticut, at 
the beginning of the Berkshire range, 
it possesses all the well-known features 
of this famous region, without quite so 
much of the " civilizing " influences of 
the resorts farther north in this section 
apt to annoy and grate on one with 
sensitive nerves and easily irritated. 
It is quite well known as a resort and 
possesses good accommodation for all 
desiring to avail themselves of its 
beauties. Is usually filled to overflow- 



Treatment. 83 

ing during the summer months, but 
owing to the class of people going there 
one would never be inclined to think 
this the case, not by any means lonely, 
but simply that one is not encroached 
upon in fact or visually by the species 
of individuals so common in most of 
our summer resorts. Besides not being 
a business centre or having any manu- 
facturing interests, it is possible for it 
to be what it appears to all w r ho have 
ever been there, an ideal New England 
town, remarkably beautiful and exceed- 
ingly healthy. Its situation being little 
over two miles back from the railroad 
station, it is possible for it to maintain 
its freedom from too much of the 
" progress" so common to the majority 
of our towns. 

From this description the writer dis- 
claims any intention of advertising this 
place, but simply to make known a de- 
sirable spot for a summer resting, one 
where we do not have to pa}' the 



84 Treatment. 

penalty of expiating all winter for un- 
hygienic conditions experienced, and so 
common to many of us after our sum- 
mer sojourn in pursuit of health and 
pleasure. 

For a class of cases who not only can 
stand but may need the stimulating 
climate of a higher altitude, besides 
also a certain amount of social enjoy- 
ment, I do not know of a location 
more desirable than Lake Minnewaska, 
situated at an altitude of about two 
thousand feet above sea level, where 
we have a genuine mountain climate 
amidst beautiful surroundings, both 
near and far, with many advantages not 
obtained at other resorts, and entirely 
free from the turmoil and bustle found 
at the majority of the summer resorts, 
especially those but a short distance 
from the cities. 

For parties but slightly affected and 
well enough to travel, the White Moun- 
tain region is a more desirable section 



Treatment. 85 

to recuperate in, of which there are 
many points to settle at, Bethlehem be- 
ing considered the centre. 

In the case of patients with asthmat- 
ic complications a high altitude may 
be necessary, but if in any of the con- 
ditions insomnia is induced, it is indica- 
tive that the heart is being affected and 
that a lower altitude is to be sought at 
once. 

A certain proportion of these cases do 
better at the seashore, and for such 
where a mild salt climate is desired I 
know of none better than the Connecti- 
cut shore of Long Island Sound as pos- 
sessing a balm-like quality, and excep- 
tionally free from all irritating prop- 
erties of so frequent occurrence in many 
of our sea shore climates. 

For a genuine pure and unadulterated 
seashore with a climate possessing 
qualities fully equal to an ocean voyage, 
all this is attributed to the coast of 
Maine and the islands of Casco Bay. 



86 Treatment. 

But the seashore resorts near the city 
are the very last places for us to send a 
patient requiring quiet and absence of 
irritating influences, with their noise 
and confusion, as staying at home 
would be of much less injury to them. 

Long Island with its grand expanse 
of ocean and endless opportunities for 
the sportsman, besides an object on 
which much money has been lavished 
not always wisely, is not a location for 
us to send our patients to for many hy- 
gienic reasons. This may savor of 
heresy to the decrees of fashion, to the 
devotees of which this section of coun- 
try is a veritable Mecca. 

The writer does not wish to be under- 
stood as claiming that the places here 
enumerated are the only locations in 
which the debilitated and enfeebled may 
again become strong and well, but sim- 
ply in his opinion as advisable to recom- 
mend to our patients when in need of 
such. 



Treatment. 87 

Bowels. A tendency towards consti- 
pation should not be allowed. One 
daily movement of the bowels, at least, 
should be invariably encouraged, either 
by habit, diet, enema, or even as a last 
resort by means of drugs. 

Rest. Early hours for sleep should 
be enforced; not less than nine hours 
out of the twenty- four being essential 
in these cases, and even more in the 
very debilitated ; but as a rule, prefer- 
ably at the regular sleeping time, un- 
less in the very weak, so as to allow of 
the opportunity to derive as much bene- 
fit from the sunshine, fresh air, etc., 
during the day. 

Recreation. A very important point 
to gain with these patients is to draw 
their attention away from thinking too 
much of their ailments, either by means 
of some agreeable occupation or some 
easy outdoor work, even to the cultiva- 
tion of a simple " hobby n to keep them 
engaged and their minds diverted, to 



88 Treatment. 

prevent a brooding over their bad feel- 
ings and their complaints.^ 

This point gained, mnch will have 
been accomplished as a means of remedy- 
ing the evil. 

Water. As to this a water with as 
little solids as possible is the most desir- 
able, and that containing lime and iron 
in too large quantities is apt to cause 
an aggravation of this trouble and is 
to be especially avoided. Pure water 
must be ever considered an absolute 
essential to the maintenance of perfect 
health. 



TREATMENT. 

Diet. 

This is without doubt the most es- 
sential factor in the treatment of this 
condition, as by these means the 
quantity of waste products in the sys- 
tem can be either increased or dimin- 
ished ; its alteration easily effected and 
in a short time so acting on the excre- 
tion of the uric acid, a diminution of the 
nitrogenous or xanthin diet lessening 
its formation ; but to remove the pres- 
ent accumulations resulting from the 
past, if in any considerable quantity, is 
a matter of months at the very least, if 
not years. 

The diet of the uricacidaemic patient 
should consist of no articles containing 
uric acid or any nitrogenous matter 
from which this substance can be 



90 Treatment. 

formed, as animal food, fish, etc., and 
in some cases even eggs ; nor should the 
xanthin bodies, tea, coffee, or cocoa, — 
substances which in their passage 
through the human body become con- 
verted into uric acid — be permitted at 
all under any circumstances whatever. 

A diet as the above, stimulating as it 
is, by rendering the blood acid (less al- 
kaline) , keeps the uric acid out of it ; 
therefore, although the patient may feel 
well during the intervals, when the 
system becomes too overcharged with 
the waste products, as it surely will, 
then due to its overflow and increased 
excretion, we have the so-called " uric 
acid storms," as headache, bilious at- 
tacks, etc., a change of diet is absolutely 
essential. 

Animal food not being absolutely es- 
sential for perfect nutrition, this end 
can be attained by means of the vege- 
table kingdom, although of a neces- 
sarily bulky nature on account of the 



Treatment. 91 

larger amount required^ there being a 
lower proportion of albuminoids present 
in them, as also water. 

Milk and cheese have no power in in- 
creasing the formation of uric acid, and 
on account of their valuable nutritive 
properties may be used as a substitute 
for animal food. 

However, a diet will be necessary to 
provide enough nitrogen to keep the 
area at three and a-half grains per 
pound of body weight during the 
twenty-four hours — no more or no less 
— estimating the patient's weight minus 
fat, t. e., what he weighed before becom- 
ing fat, if so. The determination of 
this substance may be made with the 
Doremus Ureometer as of sufficient ac- 
curacy; but for uric acid, the process be- 
ing tedious and complicated, is not 
adapted for the busy practitioner's use. 
The determination of the urea, how- 
ever, will be sufficient, and by this 
means we may be enabled to keep track 



92 Treatment. 

of the patient's condition, and as it is 
also necessary to maintain the proper 
body nourishment to prevent the loss 
of flesh and strength, with the animal 
foods left off, this must be replaced by 
other substances containing albu- 
minates ; as, for instance, milk with a 
percentage of three to four per cent., 
cheese thirty-three, peas or beans 
twenty-two, bread eight, and oat meal 
twelve ; taking of these an equal 
quantity of peas, beans or cheese, or of 
the others in an amount proportionate, 
any of these will fully replace meat 
with its average of twenty to twenty- 
five per cent, of albuminoids, supplying 
an equivalent as satisfying and efficient. 

By these means we are thus en- 
abled to maintain the urea in proper 
quantity, together with the nutrition 
and strength not at all affected. 

Should the bulkiness of this form of 
diet produce dyspeptic symptoms or 
gastric derangements, or, for variety, 



Treatment. 93 

the various gluten preparations will be 
found of inestimable value as foods. 

There may be cases met with, very 
rarely however, where these articles of 
diet do not seem to be sufficiently 
nourishing, where the patient loses 
strength; in which case we may be com- 
pelled to allow the use of such articles 
as fish, chicken (turkey is not advis- 
able), eggs, etc., but endeavor to have 
the patient avoid all red meats as much 
as possible, and only use them under 
the most urgent circumstances. 

This outlined diet is that recom- 
mended for the most severe cases ; 
but in the milder forms, although best 
without, still meat once a day may be 
allowed, but tea and coffee should be ab- 
stained from entirely, until at least the 
patient is free from all troublesome 
symptoms and the urine is free from 
an excess of urea, when coffee once a 
day, not too strong, may be permitted ; 
but tea at no time should be taken as a 
beverage. 



94 Treatment. 

As to meat, in these individuals, at 
no time should they eat it more than 
once a day, even when apparently well, 
and in the case of sedentary persons it 
is advisable that total abstaining from 
it at all times be the rule. 

In fact, it is the opinion of the writer 
that none but a hard working laborer 
should eat meat more than once a day, 
as in such a case, on account of the 
usually excellent workings of his meta- 
holistic functions, a diet of any kind 
should be digested without the slight- 
est particle of trouble. But even here 
I think that meat not eaten at all and 
the albuminates replaced by oatmeal or 
wheatena he would be better off in the 
end. 

It would seem that a suggestion to 
to the poor man that he dispense with 
the use of meat is apt to be usually 
resented as an affront, as to him and 
his family its use is as essential on the 
same principle as a carriage and horses 



Treatment. 95 

are to the parvenue, a necessary factor 
to keep tip and maintain a quasi social 
standing in his " set." 

In all others, especially the sedentary 
and brain workers, an excess of animal 
food is liable to generate a condition of 
uricacidaemia in a more or less aggra- 
vated form, and at the very least in the 
latter class of individuals, clouding the 
intellect so as to incapacitate for good 
work ; together with, in the cases of all, 
the ever present liability to generate 
ptomaines in the body of a toxic nature 
which in its errand of mischief finishes 
up what the uric acid leaves undone. 

Especially in children is the ab- 
stenance of animal food to be en- 
couraged, as in them it causes a condition 
of apparent anaemia due to spasm of the 
vaso motor nerves, relief from which 
ensuing on the discontinuance of this 
diet for one of a more hygienic nature. 

The use of eggs as an article of diet 
may be borne well and resultant of no 



96 Treatment. 

bad effects, but although not containing 
uric acid or any of the xanthin group, 
yet in some cases brings about a large 
increase of this product in the urine, 
and in such should be avoided. 

Haig also includes as producers of 
uric acid, the various pulses, as peas, 
beans, etc.; when should we find in a 
patient, on a diet in which they are al- 
lowed, a continual large excretion of 
urea, it would be well to stop them for 
a time at least to ascertain if they are 
at fault. 

Experience has demonstrated that 
one who has been on a uric acid form- 
ing diet, on giving it up suddenly, will, 
while the urates are passing out, feel 
wretched and despondent, as also 
weak and disinclined for any kind 
of work ; therefore, in cases where we 
have large accumulations in the system, 
it is best to gradually wean the patient 
from the habit of a meat and xanthin 
diet, as the sudden change may bring 



Treatment. 97 

about a serious condition of high blood 
pressure and its results, owing to the 
outpouring of the excess of uric acid 
from the tissues in the blood ; a condi- 
tion more liable to occur in the middle 
aged and old people, the manifestations 
being from vertigo in a mild case to 
apoplexy in a severe one. 

Fruit and vegetables should at all 
times enter largely into the diet, and 
according to Burnett, in writing upon 
this subject, he says, " The tissues of 
those who do not eat fruit and vege- 
tables show signs of decay and senility 
at an age much earlier than in those 
partaking largely of these articles of 
diet." 

Vegetables contain a large propor- 
tion of water, but are valuable on ac- 
count of their mineral constituents, in- 
creasing the alkalinity of the blood, 
and consequently solvents of uric acid, 
especially potatoes and spinach, also 
Brussel's sprouts, cabbage, cauliflower 
7 



98 Treatment. 

and peas. Of these, cauliflower con- 
tains 1.53 per cent, albuminates, spin- 
ach 3.15 per cent., and Brussel's 
sprouts 4.83 per cent., thus making 
them of considerable nutritive value 
also. 

Regarding the cereals, wheat con- 
tains 14.15 per cent, proteids, while 
oats, somewhat less, yield 11. 12 per 
cent, of the same. 

Fruits as an article of diet, although 
possessing a low nutritive value, con- 
sisting largely of water, and of their 
solids only a small proportion of nitro- 
genous matter ; their chief food value 
is in the sugar they contain, which is in 
considerable amount ; its advantages 
consisting of its ready solubility, need- 
ing no previous digesting, although 
when used with other articles of diet is 
apt to give rise to acidity and flatulence 
in dyspeptics and in individuals with a 
weak digestive apparatus, due to an 
acid fermentation in the alimentary 



Treatment. 99 

canal ; still, when partaken of alone as 
is advised in these cases, this possibility 
is avoided; but in all cases, however, 
their use should be begun sparingly 
and with care. 

Another important class of ingre- 
dients are their salts composed of the al- 
kalis in combination with the vegetable 
acids, malic, citric, and tartaric, to- 
gether with some free acid as well, 
which, all being converted in the sys- 
tem into carbonates, these acids (unlike 
the inorganic) exert no restraining in- 
fluence on the uric acid excretion, 
while the alkali lessening the acidity of 
the urine and increasing the alkalinity 
of the blood thus constitute conditions 
more favorable for the excretion of the 
uric acid ; especially at this particular 
period (breakfast), when the excretion 
of this product is at its maximum (9--12 
A. m.), a diet of this description aiding 
rather than hindering, as some do, the 
outflow, is peculiarly of advantage, as 

LofC. 



ioo Treatment. 

the average diet tends rather to drive 
the uric acid into the tissues than aid 
in its elimination. 

Under no circumstances, however, 
should sour acid fruits be partaken of 
by these individuals, as the system be- 
ing weak and the acid in excess, due 
to this tax upon the system, their con- 
version into carbonates as in the nor- 
mal condition may not be possible 
under these circumstances, together 
with a lessening of the alkalinity of the 
blood driving the uric acid into the tis- 
sues and a diminishing of its excretion, 
which at this time should be at its 
maximum ; later on in the day it will 
again enter the blood at a time when it 
should be at its minimum, therefore 
causing various disturbances and symp- 
toms indicative of its presence in large 
amounts. 

In the normal state, although fruit 
acids may lessen the alkalinity of the 
blood, it is of but short duration when 



Treatment. 101 

the acids are broken up into carbonates, 
the alkalis then coming into action 
and reversing the effects. 

When fruit has not been partaken of 
previously b}^ the individual to any ex- 
tent, it may set up an uric acid storm, 
with symptoms of headache, bilious at- 
tacks, etc., this condition being due to 
a stirring up process of the retained 
waste products in the system, the 
blood becoming more alkaline and the 
uric acid in the tissues therefore pass- 
ing into it. 

In cases of this kind it is best to be- 
gin cautiously and increase the amount 
of fruit eating gradually, when it will 
not only be tolerated, but a beneficial 
action will in a short time be experi- 
enced in the prevention of the forma- 
tion of an excessive quantity of uric 
acid. 

As to the kinds of fruit to be eaten, 
preferably are advised apples, grapes, 
oranges or peaches ; eating as much as 



102 Treatment. 

the patient desires, but of course not 
carrying the amount to excess. 

In many cases much benefit is de- 
rived from a breakfast of nothing but 
fruit, and no other article of diet eaten 
before twelve o'clock, noon, except 
plenty of water during the intervals be- 
tween meals. 

Preserved, cooked, or dried fruits will 
not answer the purpose at all, and no 
sugar should be used with them, as 
fruit sour enough to require sugar to 
make it palatable is deleterious to these 
cases. 

Two or three months of this diet will 
be necessary, when the patient may re- 
turn to a proper mixed diet, when, 
should the symptoms indicate a return 
of the process of deranged nutrition, the 
fruit breakfast may be again taken up 
and persisted in until a cure is effected 
or lasting relief is obtained. 

In the case of individuals with whom 
this form of diet does not agree even 



Treatment. 103 

after repeated trials, to such we would 
advise, if it be possible for them to do 
so, to dispense entirely with their 
breakfast, taking only a glass of hot 
water or carbonated water. This latter 
might seem impracticable to those oc- 
cupied in some vocation, but as the 
class of individuals, in the large ma- 
jority of cases, afflicted with this com- 
plaint, are not, as a rule, of this class, 
but ones who have no occupation and 
can lay around and take things easy, 
therefore we need not feel any hesitancy 
in advising this mode of treatment for 
them on account of any possible incon- 
venience. 

In regard to cheese with its exceed- 
ingly high proportion of proteids (30- 
33 per cent.), in a large number of 
cases disagrees with the digestion when 
eaten alone, and even sometimes in 
combination is tasted for sometime 
after meals. It is best, when to be 
taken in large quantities, to mix with 



104 Treatment. 

some other article of diet, as macaroni, 
etc., to prevent a possible disagreement, 
and also in the cooking the addition of 
a little potassium carbonate makes it 
more easily digested. Or, it may be 
taken in the form of the so-called " cot- 
tage cheese, " which in many cases is well 
borne when the ordinary cheese is not, 
and is as fully if not more nutritious and 
certainly contains less possible adultera- 
tion. 

As to coffee, many persons are so ac- 
customed to their cup of it in the morn- 
ing for breakfast, that without it their 
meal is to them u incomplete, " as they 
express it. For such a coffee substitute 
would be allowable, as there are now 
several varieties of this made that as 
taste goes are so little inferior to the 
average home-made coffee that a large 
majority of individuals drinking it 
would fail to detect the difference in 
them, also being non-stimulating, and 
by the manufacturers claimed to be 



Treatment, 105 

very nutritious, are to be recommended 
as of especial use in these cases. 

As it is believed that in some of 
these varieties genuine coffee is added 
to impart a flavor, we must avoid such 
ones if we wish for good results with 
our patients who use these preparations. 
They are also a very satisfactory means 
of flavoring milk for those to whom the 
taste of it is not palatable. 

Milk being a very essential article 
of diet for these classes of cases, as it 
does not generate uric acid in the sys- 
tem, acts as a mild diuretic, and at the 
same time a most nutritious form of food, 
should be partaken of freely and in 
large quantities. Some individuals 
seem to be under the impression that it 
does not agree with them, makes them 
a bilious, " as they express it ; but in- 
variably we may attribute this fault to 
something other than the milk. In 
cases of dyspepsia following its use, a 
teaspoonful of lime water to the glass 



106 Treatment. 

will usually correct this, when, if in 
case it still persists, by drinking it 
slightly warm about an hour before 
meals and with no other food, as a rule 
all trouble from this will be ended. 

It would seem to one that this would 
destroy the appetite for the meal com- 
ing so soon after, but instead of doing 
so, strange to say, those who have tried 
this claim that it rather gives them an 
appetite for the following meal. 

Another very important factor in the 
treatment of uricacidsemia is the 
drinking of plenty of pure water, free 
from lime or iron, not less than six 
pints a day at the very least, and more, 
if possible, without any inconvenience 
ensuing. Most of this should be taken 
between meals, before retiring at night, 
and on arising in the morning, when, if 
the use of it at meals causes dyspeptic 
symptoms, as is often the case, none 
should be taken at this time. Under 
no circumstances whatever should we 



Treatment. 107 

drink ice water, nor even cold enough 
to chill the stomach. 

In the commencement of this diet it 
is frequent for the bread and starchy 
foods to disagree, causing flatulence 
and a sense of oppression in the stom- 
ach. This is due in part to the in- 
creased quantity taken to compensate 
for the lack of animal food, which, on 
account of its concentration, seldom 
causes this ; and another reason, that 
in meat eating, bolting, usually prac- 
ticed, by the way, is possible as the 
main factor of this digestion is in the 
stomach, but in the case of the above 
as an admixture of saliva is absolutely 
indispensable, and which not being al- 
lowed, owing to this rapid eating, as a 
result digestion is slow and fermenta- 
tion ensues. 

The use of cane sugar, when it causes 
fermentation, gives rise also to acid 
products, and when such a condition 
arises should be prohibited. 



108 Treatment. 

The action of salt tending to cause 
a deposition of sodium biurates in the 
joints and tissues, it therefore should 
be used sparingly and all salt foods 
be abstained from. In severe cases 
potassium chloride as a substitute for 
salt is advisable, on account of its less 
prejudicial effects and also its moder- 
ately diuretic action 

All acids and acid foods should be 
prohibited from the patient's diet. 

Over-eating must not be indulged in, 
as not only in these cases but is always 
predjudicial to the well being of the di- 
gestive organs. 

We hear complaints from many as to 
a feeling of " good for nothingness " to 
coin a term to fit the case, so often ex- 
perienced Mondays after a hearty eat- 
ing on Sunday, or the day following a 
holiday on which we have feasted too 
lavishly ; as in these cases meat is in- 
variably an important item in the bill 
of fare, from which we may attribute 



Treatment. 109 

the bad effects to an excess of uric acid 
formed, as the disturbing element aided 
also by the usual lessened amount of 
activity on these occasions. 

Just here a point mentioned by Bur- 
nett in his work on " Gout " might not 
come amiss. He suggests that in this 
complaint in those of hereditary ten- 
dencies and high livers a spare diet is 
not so beneficial as in those who live 
plain but from occasional high living 
are subject to its attacks. 

During one of the so-called uric acid 
storms the diet should be of the plain- 
est, and often in many cases during the 
severity of the attack nothing at all 
should be eaten, save possibly some 
warm water drunk at intervals to supply 
liquid for the system to assist the kid- 
neys in carrying off the excess waste 
products. 

In regard to the use of alcohol in 
this class of cases, it should not be 
used at all as a beverage. If stimu- 



no Treatment, 

lants are really needed at any time a 
little Scotch whiskey may be allowed 
as preferable on account of its little or 
no acidity, but port, sherry, burgundy 
and champagne, together with malt 
liquors and porter, should be prohibited 
on account of their acidity, and to 
which champagne is attributed the 
most pernicious, as the most acid. 

These are more liable to give trouble 
in the case of meat eaters than in 
those not given to this form of diet ; 
and to these contained acids is to be at- 
tributed the mischief making, as the 
action of alcohol pure is that of an 
alkali in diminishing the acidity of the 
urine and for a time increasing the ex- 
cretion of the uric acid. 

A few points as to the uric acid form- 
ing properties of some articles of diet 
might be of service to bear in mind. 

Young meat, as lamb and veal, con- 
tains more uric acid, 3.5 grains to the 
pound, than old meat, as beef or mut- 
ton, containing 1. grain to the pound. 



Treatment. in 

Kidneys contain 3.5 grains and liver 
6.5 grains to the ponnd. 

Fish has only 1. grain, but beef tea 
contains 7. grains to the pound. 

Of the xanthin compounds, which, 
as we know, while not uric acid, still in 
their passage through the body be- 
come such ; of these cocoa contains 59 
grains, coffee 70 grains, and tea, the 
largest of all, 175 grains to the pound. 

From this we can readily understand 
why the latter plays such havoc with 
the nervous system. 

As to articles suggested for diet the 
following quantities are to be recom- 
mended : 

Milk containing 3-4 per cent, albuminoids, 3-4 pints 

per day. 
Cheese containing 33 per cent, albuminoids, 2 ounces 

per day. 
Bread containing 8 per cent, albuminoids, 12 ounces 

per day. 
Oatmeal containing 12 per cent, albuminoids to equal 

2 ounces dry per day. 
Wheatena containing 16 per cent, albuminoids to 

equal two ounces dry per day. 

Besides plenty of fruit, vegetables 
and water. 



ii2 Treatment. 

In concluding this subject, as to a 
diet suitable for this condition, while to 
some it might appear but a step above 
starvation, I can assure the hesitating 
ones that their nutrition will in no wise 
suffer, and besides after giving it a fair 
trial will derive so much benefit from it, 
and feel so much better than when on a 
uric acid forming diet, that they will 
not care to return to their old habits^ 
in fact some even acquiring a distaste 
for these articles of food, although 
favorites in the past. 

Of course the difficulty will be to in- 
duce these patients to try this form of 
diet, as they cannot realize the possi- 
bility of dispensing with what they have 
considered so essential to their nutri- 
tion. But we should strenuously advise 
it and do all in our power to w T ean 
them of their bad habits, when if they 
will not take our advice the loss is 
theirs, we will have done our duty and 
on this point at least can go our way 
with a clean conscience. 



TREATMENT. 

Drugs. 

In a condition of this kind dealing 
with a substance in the system acting 
largely as a foreign body, we can readily 
understand that the first indication in 
our treatment is its removal, the excess 
waste products eliminated from the sys- 
tem ; then by diet and other measures 
its further increase and retention pre- 
vented, when by means of our remedies 
as indicated endeavor to set right what- 
ever bad results that remain. 

In many cases, however, of long 
standing and where serious organic le- 
sions have not occurred ; with old habits 
corrected, reformed diet, with an elimi- 
native treatment, proceedings that are 
absolutely essential in all cases, these 
will be all that are necessary to effect a 
8 



H4 Treatment. 

cure ; but in an individual where this 
condition has been of long duration, a 
matter of years, there is usually a cer- 
tain amount of deep-seated damage set 
up, possibly organic, which will some- 
times require long and persistent treat- 
ment to rectify, and in some cases not 
to be cured. Such as these will tax our 
knowledge of the materia medica, as 
they are to be treated purely according 
to the organ or structures involved. 

No doubt in some of these cases of 
simple excess formation and storage in 
the system, after a change in living 
and a diet stopping this increased prod- 
uct, but requiring a considerable time 
to do so, nature would gradually elimi- 
nate the superabundance of uric acid in 
the tissues and blood, but during which 
time, however, the patient would be liv- 
ing a life of utter wretchedness, de- 
pression, malaise, etc., therefore it is 
always advisable to adopt an elimina- 
tive form of treatment to get rid of this 



Treatment. 115 

as soon as possible, to start the patient 
on the right way to recovery. 

To accomplish this we have many 
agents ; in fact, the manufacturing 
pharmacist has here been particularly 
generous, as it would seem that he 
had made it a veritable target for his 
creative genius, so numerous have 
they been ; the last better than all the 
others combined and the only perfect 
one; and, as a rule, the majority of 
them after being weighed in the bal- 
ance are found decidedly wanting in 
respect to the qualities claimed for 
them. But aside from these there are 
several reliable and efficient agents 
capable of accomplishing these results 
in a most satisfactory manner, the 
properties of which we will now discuss. 

Haig advises and his apparently 
favorite method of elimination of the 
urates from the system is by means of 
the salicylates. 

By their action increasing the solu- 



n6 Treatment. 

bility of the uric acid by forming with 
it salicyluric acid, at the same time in- 
creasing the urinary secretion and thus 
carrying it out of the body. This sub- 
stance being soluble in slightly acid 
solutions and insoluble in alkaline, acts 
therefore best when the alkalinity of 
the blood is low. 

Warmth also hinders its action due 
to this raising the alkaline reaction of 
the blood, therefore its administration 
in warm weather is not as resultant of 
good as some other agents. 

It is always contraindicated when 
gastric disturbances are present, an 
existing debility or physical depression^ 
and should not be administered when 
dyspnoea or cyanosis exist or any form 
of heart disease, as it may cause heart 
failure by the increased blood pressure 
from the outpouring of the stored up 
uric acid in the blood. In certain nerv- 
ous individuals salicylates in large 
doses develop neurotic symptoms, even 



Treatment. 117 

going on to delirium ; and, as it acts as 
an irritant to the kidneys, should be 
but sparingly and cautiously given when 
they are deranged. As large doses also 
cause dyspnoea, therefore should be ad- 
ministered with care. 

When necessary, Haig advises a con- 
tinuance of this treatment for a long 
time, months or even years (1-3), as he 
claims that this may in some severe 
cases be required to eliminate the 
urates from the system stored up from 
past excessive accumulations. 

He further advises that the diet be 
not changed too soon, until the sali- 
cylates have had time to act in their 
eliminating sphere, preferring to accom- 
plish the clearing out first before stop- 
ping the excess formation. 

To insure the acidit}^ necessary to 
free the blood of uric acid, and for the 
proper action of the salicylates, he recom- 
mends its alternate use with acids, as 
nitro muriatic acid, 2-3 gtts. in half 



n8 Treatment. 

glass of water, taken before meals (a 
free dilution of it is necessary, as it 
may otherwise cause a fall in acidity 
instead of a rise in it) , and salicylate 
of sodium, x-xv grains, after meals and 
at night (four times a day) , in water or 
milk. Sometimes it is well to give at 
the same time aromatic spirits of am- 
monia, x-xv gtts., as ammonia al- 
though an alkali, still, as Haig informs 
us, in this connection raises the acidity 
of the urine and aids the excretion of 
uric acid; also assisting the action of 
the salicylates. No doubt a satisfactory 
result is obtained by the administration 
of this agent, but the reason of its ac- 
tion does not seem quite as much so. 

Under such circumstances it would 
seem well to try salicylate of am- 
monium. 

This acid (nitro muriatic) recom- 
mended simply removes the uric acid 
from the blood and drives it into the 
tissues, when the use of salicylates is 



Treatment. 119 

necessary to eliminate it from the sys- 
tem; otherwise, when the drug is left 
off, the urates return again into the 
blood, and the same old train of symp- 
toms again occurs. During this stage, 
when the blood is free, an actual state 
of stimulation exists with a lowered 
blood pressure, quickened circulation 
and pulse, with also a brightening up 
of the intellect, allowing an increased 
combustion and metabolism throughout 
the body. In subjects susceptible to 
it also producing gout. 

Another form of treatment recom- 
mended by Haig for the removal of the 
urates from the blood is by means of 
calomel in ]/^ grain tablets, 2-3 doses 
at ]/ 2 hour intervals ; or else mercuric 
iodide yi grain, 2 doses as above, fol- 
lowed immediately by the same sali- 
cylate treatment. This, as a rule, is 
necessary to be repeated for several 
days (4-5) to clear the blood com- 
pletely and effectually of these retained 
waste products. 



1 20 Treatment. 

When for any reason an agent is re- 
quired to drive the urates at once out 
of the blood for relief of present exist- 
ing symptoms, a nitrite, as glonoin 
1-100 minim, or sodium nitrite 2 grains, 
or else morphia 1-6 grain will suffice. 

In cases where mercury is contrain- 
dicated for any reason, nitro muriatic 
acid, as hitherto been suggested, is pref- 
erable. 

It may seem to some that I have 
dwelt at too much length on these 
methods of Haig, as they may not be 
acceptable to all of us, but as he being 
acknowledged the foremost authority 
on this subject (uric acid), it has 
seemed to me that we should have a 
clear idea of his views on the treatment 
of this condition; even although we 
have no occasion for its present use, 
there might come a time when all other 
means failing we would be very glad to 
avail ourselves of these measures. 

Another nitro muriatic acid method 



Treatment, 121 

recommended is the following : 3-5 
grains of this agent after meals and at 
night in a ^ glass of water ; always 
after taking rinsing the month with 
water and drinking another glassful. 
To be followed by sodium phosphate 
and alkali or else piperazine to remove 
the urates from the system. This 
treatment should be always begun a 
week or so before expected attacks if 
possible, as sick headache, etc. 

In warm weather when salicylates 
are not indicated, sodium bicarb. 30 
grains t. i. d. between meals raises the 
blood pressure and retains the urates 
in the blood so as to admit of their 
elimination, but diminishes the excre- 
tion of the urine. Potassium bicarb. 30 
grains t. i. d. has the same action as 
the above, but is more of a diuretic. 

In very many cases irrespective of 
season these agents are often preferable 
to salicylates and fully as effective ; in 
fact, in debilitated individuals they are 
much safer at all times. 



122 Treatment. 

Lithium, regarded by the laity and a 
majority of the profession as the grand 
cure-all for this— the uric acid diathe- 
sis — has been laid in the dust by Haig, 
who claims that it exercises no in- 
fluence whatever upon the excretion of 
the urates, but, as I have said before, 
combines with the phosphates of the 
blood, raising its acidity, and drives the 
uric acid into the tissues ; a condition 
of relief of but short duration, as it 
does not eliminate it from the system 
as we have hitherto been led to sup- 
pose. 

Previous to becoming aware of this 
fact, the writer had often wondered at 
the entire absence of results obtained 
by him from this drug, it never seem- 
ing to afford the slightest relief in his 
experience. 

Lithium salicylate has yielded better 
results, probably due to the action of 
the salicylic acid in this combination. 
However, in the opinion of the writer, 



Treatment, 123 

that, as there are many eliminatives so 
far superior to lithium, we should avail 
ourselves of them, and only when 
nothing else is obtainable resort to this 
agent, and then only when a salicylate. 

Phosphate of sodium for the elimina- 
tion of urates from the system, in doses 
of 30-60 grains, 2-3 times a day, not 
allowing the bowels to become too free, 
is the most effective and thoroughly to 
be relied upon for this purpose of all 
the eliminatives. To obtain the full 
benefit from it an alkaline media is 
necessary for its action ; therefore it is 
best given with sodium bicarb., as in an 
acid solution it becomes an acid phos- 
phate, an insoluble compound in the 
blood, thereby being rendered useless 
for this its desired purpose. 

Piperazine is a valuable agent for this 
condition, its directions for use being: 
15 grains in a quart of water to be 
taken in one-half glass doses through- 
out the day. 



124 Treatment. 

Gicht wasser of Wiesbaden is also 
recommended as of benefit. 

Of late a certain nnmber of organic 
compounds have been introduced with 
great claims as to their efficacy in form- 
ing soluble bodies with uric acid in the 
system, and thereby facilitating its easy 
elimination, such as : lysidine, pipera- 
zine (already mentioned), formine, ly- 
cetol, sidonal, etc. 

The value of these, with the excep- 
tion of piperazine, is as yet problemat- 
ical, although most enthusiastic reports 
are heard from some quarters regarding 
their value in these complaints, as a 
rule, however a large majority of the 
results having been obtained from ex- 
periments outside the body. But owing 
to the fact that our results in the labor- 
atory are not by any means borne out 
in the human body accounts for the fact 
that physiological chemistry is not yet 
an absolute science, and also that we 
cannot place an implicit reliance upon 



Treatment. 125 

these compounds, or others of a similar 
character, for this purpose as yet, until 
clinical experience has demonstrated 
that they are what they are claimed to 
be. Time and trial will demonstrate 
the value of these, when the good will 
rise to the top and the worthless will 
sink to the bottom. That is, it should 
be this way, as it sometimes is not. 

The following treatment has also 
been recommended for this condition : 

fy. Theobromine, 3 iv. 

Lithium Carbonate, ^iiss. 
Sodium Benzoate, £j gr. xv. 
M. S. — Divide into sixty tablets. One to be taken 
each morning. 

Administer for twenty days during 
each month, for about six months. 

An interval of two months may then 
be allowed to elapse, and the treatment 
be resumed for another six months. 

For the feeling of coldness or cold 
extremities, a common symptom occur- 
ring in these patients, nitro muriatic 
acid dilute, 10 minims in l / 2 glass of 



126 Treatment, 

water before meals, followed by the 
salicylate or soda treatment after meals. 
Recommended by Haig. 

For gout he also advises salicylate of 
methyl x-xv gtts. painted externally 
on the affected part, protected with an 
impervious covering 

Having laid before the reader a 
very wide selection of " old school" 
remedies and forms of treatment, I will 
now take up what methods are adopted 
by the homoeopathic school; its point of 
advantage being its ability to cope with 
the after conditions which frequently 
occur as a sequelae in these patients, be- 
sides by no means devoid of methods of 
its own to effect the elimination of the 
offending products when in excess. 

Ever bearing in mind the old saying 
about " two strings to one's bow," and 
the advantages of this dual capacity, 
notwithstanding which there comes a 
time when the destroying processes of 
nature are not to be vanquished by 



Treatment. 127 

either, verily it would seem that lie 
who would scorn the methods of any 
school of medicine is but half armed for 
the fray. 

Urtica urens. This remedy was in- 
troduced to the medical profession for 
the purpose of eliminating the excess 
urates from the system by the late J. 
Compton Burnett, who modestly in his 
little book on " Gout " informs us that 
it will not in all cases fulfill this func- 
tion. Such a marked contrast to the 
extravagent claims made for some of 
the exploited cure-alls, regarding which 
it would be perfectly proper to rather 
state as an antithesis that in all cases 
they will not fail, although our experi- 
ence might have led us to so infer. 
Nevertheless it is an agent of great 
worth in this class of cases, and usually 
giving satisfaction when used accord- 
ing to his directions, viz., in acute at- 
tacks 5 drops of the tincture every 2-3 
hours in a wineglass full of warm water, 



128 Treatment. 

while in the more chronic conditions, 
he advises 10 drops morning and night 
or t. i. d. in the same menstnmm. 

He does not give marked indications 
for its use, but rather suggests it on 
general principles ; still it is a remedy 
we should ever have in our mind when 
treating uric acid patients, and often 
then to administer it with the one indi- 
cated. Its results are as a rule quick 
and lasting, being not only an elimi- 
nant, but also when in conjunction with 
hygienic measures and diet a curative 
agent that is also prophylactic to the 
after effects of uricacidaemia. 

To those of our school to whom the 
dosage given above would seem as he- 
retical, a "backsliding" process, so to 
speak, the writer would say that in 
mild cases with symptoms of uric acid 
retention he has obtained very satisfac- 
tory results from doses of ]/ 2 to i drop. 

Aurum muriaticum 3X v. gtts. in 
water every three hours is a most excel- 



Treatment. 129 

lent remedy given on general principles 
for the various sequelse of uricacid- 
semia, for the conditions remaining 
over after the stored up products have 
been excreted and a new diet instituted; 
its characteristic symptoms being great 
mental depression, and in old and worn 
out subjects. 

The various conditions in which it 
will be found useful are the following : 
Cardiac hypertrophy, powerful action, 
with rush of blood to head and chest ; 
palpitation of the heart ; high blood 
pressure. Arterio sclerosis. 

Different varieties of neuritis, as also 
neurasthenia. 

Interstitial nephritis ; early and late 
stages. 

Hepatic cirrhosis ; sclerotic stage. 

Spiritus glandium quercus x. gtts. of 
the tincture in water t. 1. d., also recom- 
mended by Burnett, is another valuable 
remedy in the case of old alcoholics and 
high livers. He claims that it will di- 
9 



130 Treatment. 

minish if not remove the craving for 
spirits. Disease of the spleen is one of 
its chief characteristics, with pain in 
that region. 

The following is a classification of 
the various conditions developing from 
uric acid as a causative factor, together 
with their appropriate remedies as in- 
dicated for them : 

1. Nervous system: Arsenic alb., 
aurum muriat., kali iod., spigelia. 

2. Heart and Circulation : Arsenic 
alb., aurum muriat., cactus, berberis, 
chelidonium, china, iris versic, mercur. 
dulc, nux vom., podophyllum. 

4. Respiratory Tract : Arsenic alb., 
arsenic iodide, grindelia, kali iodide, 
sulphur. 

5. Urinary Tract and Kidneys : Ar- 
senic alb., aurum muriat., berberis, can- 
tharis, coccus cacti, ferrum phos., kali 
chlor., lycopodium. 

6. Gout : Colchicin 3. 
Arsenicum album $x. Asthmatic at- 



Treatment. 131 

tacks ; especially during the intervals, 
with co-existing heart disease, restless- 
ness and wheezing. 

Prostration after all attacks ; cardiac 
palpitation, precordial pain, dyspnoea, 
weak heart, rapid irregular pulse. Ar- 
terio sclerosis. 

Angina pectoris, in the intervals only. 

Interstitial nephritis, both acute and 
chronic forms. 

Neuralgia, worse from cold, inter- 
mittent, periodic. 

Neuritis, burning pains. Neuras- 
thenia. 

Gastritis, vomits everything taken 
into stomach, excessive prostration. 

Arsenic iodide jx. Hay fever, rhinit- 
is, sneezing, acrid discharge from nose, 
mucous or watery prostration. 

Berberis tinct. Gall stone colic, 
pains, burning and boring. 

Lancinating or throbbing pain in 
the kidneys, worse sitting or lying and 
on rising from stooping ; better stand- 
ing. Urine turbid, bloody or scanty. 



132 Treatment. 

Cactus ix. Cardiac hypertrophy, 
palpitation, and congestion ; feeling of 
constriction. 

Cantharis ix. Bnrning pain in the 
kidneys ; constant nrging to nrinate, 
only a few drops passing, with burning 
pains ; scanty burning urine. 

Chelidonium tinct. Chronic conges- 
tion of the liver, pain under inner angle 
of right shoulder ; sallow skin ; yellow 
coated tongue ; dull headache ; consti- 
pation ; fullness in region of liver ; 
sharp stitching pains ; radiating to 
right shoulder ; gall stone colic ; bilious 
headache ; migraine, with nausea and 
vomiting of bile. 

China 6x. Claimed to prevent the 
tendency to formation of gall stones. 

Hepatitis. Periodicity. 

Coccus cacti tinct. Renal colic. Uric 
acid stone. 

Colchicine $x. Acute attacks of gout. 

Ferrum redactum 2x. Anaemia, 
chlorosis ; pale skin ; sudden flush- 



Treatment. 133 

ings ; chilliness ; headache ; hemo- 
globinuria ; amenorrhoea or excessive 
menses. 

Ferrum pkos. jx. Interstitial ne- 
phritis ; hemoglobinuria ; urine brown 
or blackish red. 

Grindelia tinct. Asthmatic attacks. 

Iris versicolor tinct. Sick headache, 
beginning with blur before the eyes, 
followed by nausea and vomiting of 
mucus and bile. Pain over liver ; grip- 
ing pains. 

Kali chlor., jx. Hemoglobinuria ; 
urine brown or blackish red. 

Kali iodide, one grain doses. Asthma, 
wheezing, tightness of chest. 

Promotes the absorption of effusions. 
Nasal discharge watery. 

Lycopodiiim jc. Pain in back. Uric 
acid sediment. Uricacidaemia in men. 

This drug for this condition is as 
largely overrated in our school as is 
lithia by the " old school." However, 
some good results have been obtained 



134 Treatment, 

from the use of tlie tincture in these 
conditions. 

Mercurius dulcis 2x. Liver enlarged 
and sensitive ; tongue coated thick yel- 
low ; bad breath ; j aundice ; clay colored 
stools ; tongue retaining imprints of 
teeth ; gums sore ; salivation. 

Naja $x. Palpitation in cardiac 
hypertrophy ; oppression. 

Natrum muriat. 12c. Neuralgia ; 
neurasthenia. 

Nux vomica tznct. Cirrhosis of the 
liver ; gastric symptoms in high livers ; 
fullness and pressure in stomach ; 
vertigo ; pain in back of head. 

Podophyllum ix. Congestion of 
liver ; fullness and pain on right side ; 
jaundice ; bilious headache, with blur 
before the eyes ; vertigo ; vomiting of 
bile. 

Phosphorus $x. Hepatic cirrhosis 
and fatty liver. 

Interstitial nephritis ; nervous de- 
bility ; albuminous and bloody urine ; 
neurasthenia. 



Treatment. 135 

Sepia $x. Chronic liver disorders 
especially in females ; dark haired ; 
sallow complexion. Uricacidsemia in 
women. 

Spigelia tinct. Heart ; violent pain ; 
irregular action ; palpitation ; irregular 
pulse ; syncope. Neuralgic affections. 

Sulphur 6x. Asthma of gouty or 
uric acid subjects ; chronic conditions. 

To promote the reabsorption of in- 
flammatory products. 

Thlaspi bursa pastoris tinct., v-xxx 
gtts. Hematuria. 



136 Treatment. 



A typical case in the writer's experi- 
ence will better demonstrate these prin- 
ciples. 

X , 45 years of age, possessing 

an inherited gouty diathesis ; (paternal) 
from a child had always been an exten- 
sive meat eater and drinker of tea, car- 
ing little for vegetables and not drink- 
ing much water. 

Occasionally throughout childhood 
had been subject to sick headaches, but 
after the age of 21 they became more 
severe and frequent, occurring from the 
slightest provocation, as a trivial error 
in diet, a little too much exercise, at- 
tending a crowded assemblage, espe- 
cially when the air was not pure (more 
likely in the morning) , and as for a rail- 
road trip, that seemed to have an espe- 
cial action in laying him up completely, 
so that traveling became a veritable ob- 
ject of dread. 



Treatment, 137 

These headaches usually coming on 
at midday, reaching their severity by 
night, with nausea and vomiting of 
bitter liquid and food last eaten. 

When on sleeping through the night 
would awaken in the morning usually 
free from the headache, and remaining 
well for the time until the next attack, 
this coming on, acting and lasting about 
the same as the last. 

As to periodicity, would occur about 
once a week, sometimes more often, oc- 
casionally less frequently, the inter- 
vals between these attacks being shorter 
in the cold weather than in summer, 
when they were very rare. 

At all times the patient was very sus- 
ceptible to the cold, it sometimes amount- 
ing to almost actual suffering ; besides 
possessing a tendency to take cold on 
the slightest exposure to the air. 

These headaches coming on fre- 
quently from ordinary fatigue, and es- 
pecially so from exercising in the cold 
out of doors. 



138 Treatment. 

But by following out the ideas pro- 
mulgated in this book, the patient has 
for the last three years been almost en- 
tirely free from these headaches, only 
on certain rare occasions appearing to 
remind him of the past. 

Railroading still is not possible with- 
out sometimes causing trouble, but this 
is not as bad as it was once. In sum- 
mer, when the doors and windows of the 
cars can be kept open, experiencing 
little inconvenience, but when in cold 
weather with the usual bad ventilation, 
the old complaint is very likely to show 
itself, but even then in a milder degree 
of severity. 

Also the suffering from the cold lias 
become considerably diminished, so that 
even the exceedingly raw climate of 
Brooklyn has become tolerable without 
causing the usual amount of suffering 
as hitherto. 

The patient previous to this treat- 
ment on consulting physicians invari- 



Treatment. 139 

ably received the same advice from all, 
" take exercise," the result of which, if 
not sparingly indulged in, to again 
bring on the old trouble, but this sug- 
gestion, if made by him to anyone, to 
be received with incredulity as some- 
thing ridiculous or impossible. 

Applying the principles enumerated 
in this book to this condition, it is easy 
to understand the reason of the above 
occurrences ; knowing that an unusual 
exertion calls into play an excess met- 
abolism and its consequent process of 
combustion in the system, an enlarged 
amount of waste products, and a body 
already charged with them unable to 
throw off the amount now present, any 
increase is sure to be felt and conse- 
quently cause trouble. 

Such was the case here in one suffer- 
ing from uricacidsemia. 

Remembering at all times in this 
condition, the indications are : Get rid 
of the increased waste products in the 



140 Treatment. 

system, prevent an excessive reforma- 
tion, when exercise will be rather a 
source of pleasure than a cause of dis- 
comfort, even suffering. 



CONCLUSION. 

Thus ends my work for the present 
time, although this by no means ex- 
hausts the subject or is entitled to be 
considered as complete, which, owing 
to its complexity, will be long before it 
is perfectly understood, if ever. 

However, the dawning light has al- 
ready burst forth and we now have 
some dim perceptions regarding uric 
acid from which it is possible to gather 
a somewhat intelligent idea. 

The uric acid diathesis is still by 
some considered a myth, as non- exist- 
ing ; but to all of this opinion we feel 
very much like saying with " Romeo," 
in the work of the immortal Shakes- 
peare, " He jests at scars who never 
felt a wound." In short, because the 
scoffers and doubters have never met 



142 Conclusion. 

with a case of this kind, therefore it 
cannot exist. 

We, of the medical profession, some- 
times change onr views, therefore this 
course is still always open to the 
doubters. 



INDEX. 



PAGE 

Acids, no 

Acid tide or period, 26, 58 

Acidity caused by beers, wines, etc., 32 

Acidity of the blood, 36 

Acidity caused by fevers, . . . . 34 

Acidity caused by alcohol, 34 

Acid urates, 22 

Action of cold, 39 

Air, 75 

Alkaline tide, 25, 58 

Alkalinity decreased by cold, 25, 30, 34, 52 

Alkalinity increased by exercise, 25 

Alkalinity increased by warmth, 30, 52 

Alcohol, no 

Alcohol as a cause, 40 

Alcohol, use of, 66 

Anabolism, . 18 

Anaemia, cause of, 44, 48 

Angina pectoris, 59 

Animal food diet, a cause of, 40 

Arterial pressure raised, 58 

Arterio sclerosis, . , . . 59 

Asthma, 58 

Aurum muriaticum, 12S 

Bathing, 70 

Baths, cold not advisable, 71 



144 Index. 

Baths, cold checks the elimination of uric acid, . . 71 
Baths, cold cause of cardiac and renal lesions, . . 73 

Baths, hot preferable, . 71 

Bethlehem, N. H., as a resort, 85 

Bilious epoch, 8 

Bowels, 87 

Breakfast, abstaining from, 102 

Breakfast, fruit, 99, 102 

Burnett, J. Compton, 97, 109, 127, 129 

Calomel, 119 

Camping out, 79 

Cardiac lesions, 59 

Casco Bay, 85 

Cereals, 98 

Cheese, 91, 93 

Cheese, cottage, 85 

Children should not eat meat, .95 

Circulation, action of uric acid on, 42, 43, 58 

Classification of remedies, 130 

Climate, 80 

Clinical case, typical, 136 

Clothing, 75 

Coffee, ..40 

Coffee substitutes, 104 

Cold, effects of, 53, 72 

Cold extremities, . 125 

Coldness and chilliness, 49, 125 

Colloid uric acid, ...... 28, 39, 43 

Conclusion, 140 

Connecticut shore of Iyong Island Sound as a resort, 85 
Cures not possible by drugs alone, 67 

Definition, 15 



Index, 145 

Depression, 49 

Diathesis, uric acid, 38 

Diet, 89, 92, no, in 

Diseases attributed to uric acid, . . . 37, 42, 51, 52, 60 

Diseases following uric acid storms, 45 

Diseases of old age due to uric acid, 51 

Drugs, 113 

Drugs making blood acid, 33 

Drugs making blood alkaline, 32 

Eggs as an article of diet, 95 

Kliminants of uric acid, 114, 124, 128 

Elimination of uric acid, 22, 23 

Elimination of waste products, ........ 66 

Etiology of uricacidsemia, 35 

Exercise, 68 

Exercise influences the amount of uric acid in the 

blood, . . . . 25 

Exercise, excessive, aggravates condition, .... 69 

Fatigue, 51 

Fatigue due to excessive quantity in the blood, . . 27 

Fevers cause acidity, 2S 

Flatulence and dyspepsia from diet, ....... 107 

Food influences amount of uric acid in the blood, 

99, 102 

Fruit, 97, 98, 100 

Fruit, alkaline salts in, 99 

Fruit, avoid sour, 100 

Fruit, breakfast, 99, 102 

Gicht wasser 124 

Gout, 50, 109, 126, 127 

Gout and rheumatism identical, ^6, 50 



146 Index. 

Haemoglobin, consumption of, 49 

Haemoglobin, deficiency of, 49 

Haemoglobinuria, cause of, 44 

Haig, 115, 117, 118, 119, 120, 122, 126 

Hay fever, 61 

Headache, 54 

Hobby, cultivated, ,67 

Homoeopathic treatment, 126, 131-135 

Hot water the ideal heating system, ...... 78 

Hygienic principles, 65 

Hygienic treatment, 68 

Indications for treatment, 66 

Insomnia, 49 

Introduction, 7 

Irritability, . 49 

Katabolism, 18 

Kidneys, derangement of, 49, 59 

List of remedies, 131-135 

Lithia, action of, 33 

Lithium, 122 

Lithium salicylate, !, 122 

Liver, derangements of, 49 

Maine, coast of, as a resort, 85 

Malaise, 51 

Malarial epoch, . 9 

Meat eating, 94 

Medium altitude preferable for these cases, .... 80 

Mercuric iodide, 119 

Metabolism, 17, 18 

Milk, 91, 105 

Minnewaska, Lake, as a resort, 84 



Index. 147 

Neurotics most frequent subjects, 47 

Neurotic rhinitis, 61 

Nitro-muriatic acid, 118, 120 

Occurrence of uric acid, 22-23 

" Old school " treatment, . . 1 15-126 

Origin of uric acid, 20 

Out-of-door life essential, 76 

Pathology, 42 

Piperazin, 121, 123, 124 

Potass, bicarb, 121 

Prevent accumulation of uric acid, 66 

Recreation, 87 

Relation of uric acid to urea, importance of , . . . 29 

Rest, 87 

Rheumatism, 50 

Salicylic acid, 115 

Salt and salt foods, 108 

Seashore or mountains not as advisable as medium 

altitude for resort, 80 

Sharon, Conn., a most desirable resort, 82 

Sodium bicarb., 121 

Sodium phosphate, 121, 123 

Solubility of uric acid, 25 

Spiritus glandium quercus, 129 

Steam heat undesirable 76 

Sugar, cane, 107 

Symptoms, 42 

Synonyms, [3 

Tea, 40 



JAN 21 1903 



148 Index. 

Temperaments, effect of uric acid upon, 62 

Temperature influences amount of uric acid in the 

blood, 25 

Tired feeling in spring, 30, 31, 52 

Tobacco as a cause, . 40 

Treatment, 64, 87 

Treatment, general remarks on, 64 

Urea, determination of, 91 

Uric acid, amount of, eliminated, 22-23 

Uric acid epoch, 10 

Uric acid, occurrence of , . . . . . 22-23 

Uric acid, origin of, 20 

Uric acid, solubility of, .... 25 

Uric acid storms, 44, 59, 89, 109 

Uric acid, quantity of, in the blood varies, ... 25 
Urine, increase of, with uric acid in the blood, . . 31 
Urtica urens, 127 

Ventilation bad in churches, 56 

Ventilation in crowded assemblages, 56 

Water drinking, 88, 106 

Water drinking, too little a cause, 40 

Whiskey, Scotch, no 

White Mountains, - 84 

Wines, no 

Wood fires most desirable, 78 

Woolen underwear, 75 

Xanthin bodies, in 

Xanthin diet, . 40 






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